Are We Finally Ready to Invest in People, Not Prisons?

For the addict - and for all of us - prison reform can’t come soon enough.

Posted Jul 22, 2015

Source: Photo purchased from iStockphoto, used with permission.

I sometimes wonder where we’d be today if instead of declaring war on drugs in the 1970s, we had declared ourselves ready to help substance users quit.

It’s a sure bet we wouldn’t now have statistics like these:

  • The U.S. has the world’s largest prison population.
  • About half of all federal prisoners and about 1 in 5 of all state prisoners are serving time for a drug offense.
  • Well over half of those in our prisons and jails meet the criteria for substance abuse or addiction. Yet only about 11% get any kind of addiction treatment.
  • After mandatory minimum sentencing was introduced in the 1980s, the federal prison population grew by close to 750% to its current 207,847. Costs also soared by almost 600%.
  • The nation spends more than $80 billion each year to imprison those who “often have only been engaged in nonviolent drug offenses,” according to President Barack Obama.

It is this grim legacy that Obama referenced as he renewed his calls for prison reform recently, while commuting the sentences of 46 nonviolent drug offenders, almost a third of whom had been sentenced to life in prison.

For too long, he said, harsh mandatory sentencing guidelines, mostly involving drug use, have been disproportionately affecting minorities and the poor, and costing both those who are imprisoned and the society paying for that imprisonment far too much.

A Smarter Approach

I agree with the president that a smarter and much more compassionate approach is long overdue, including greater use of alternatives to prison such as drug courts and community addiction treatment, a total redo of sentencing requirements, and punishments that fit the crime. He’s not alone in calling for change. Hope is strong that bipartisan Congressional support can be summoned for a prison reform bill that would give judges more leeway in sentencing, increase inmate access to educational and drug treatment programs, and offer a path to early release for some drug offenders.

Even before this activity, many states across the country have begun to implement their own changes to punitive drug laws. It was the resultant state successes in reducing inmate population and recidivism, in fact, that inspired many of the provisions found in legislation currently being debated by Congress.

These kinds of reforms can’t come soon enough for those on the receiving end of what we now recognize as unduly punitive sentencing or for the taxpayers who are footing the bill. Simply diverting just 10% of offenders in the state prison system to community-based addiction treatment has the potential to save the criminal justice system $4.8 billion, according to a study by researchers at RTI International and Temple University. And this is simply the financial benefit. Most crucially, a person who is helped to overcome drug use not only reclaims their own life, they are again able to participate in the lives of their loved ones and be a contributor to their community.

Getting to the Root of Addiction

No matter the reforms we end up making in our criminal justice system, ultimate success in ending the nation’s drug use epidemic will require more than just political will. It requires better understanding from all of us about the nature of addiction.

That includes recognizing that addiction is a disease that affects both the brain and behavior, and those who have it need treatment (and, yes, compassion) just as someone with cancer or diabetes does. The first use of a substance is a choice, but some are more vulnerable to developing a problem as a result of that choice than others due to factors that include genetics, environment and a history of trauma or psychiatric disorders. Putting someone behind bars and expecting them to come out knowing how to resist the old triggers to use is a recipe for recidivism.

The good news is that when treatment is offered — even when it’s demanded by the courts rather than entered into voluntarily — it can work, especially when it is long term. That means we must be OK with establishing resources that follow the person into the community and with creating opportunities (especially hiring opportunities) for those who need the “second chances” that Obama referenced in his call for reform.

It’s also important to recognize the role that mental illness plays in substance use and addiction. For many, drugs become a way to self-medicate anxiety and depression and to escape the unbearable thoughts that come with issues such as emotional trauma. About a third of people with mental illnesses and about half of those with severe issues such as schizophrenia and bipolar disorder are dealing with substance use, notes the National Alliance on Mental Illness. Which came first is not always clear, but what is clear is that both must be addressed if there is to be any chance of true healing.

No one is saying that those who commit crimes involving drugs should go unpunished, but it’s important that we move away from our criminalization of addiction itself, especially when those who are dealing with it are so often fleeing pain rather than seeking pleasure. Hanging onto our scorn and contempt for the addict keeps stigma alive, making a person less likely to reach out for help before things spiral out of control, and diminishing the chances of reaching them before they end up in the system. When that happens, we all pay the price.

David Sack, MD, is a psychiatrist, addiction blogger and CEO of Elements Behavioral Health, a nationwide network of addiction treatment programs that includes Promises Treatment Centers in California and Lucida Treatment Center in Florida.