Incarceration, Substance Abuse, and Addiction

Policies related to the War on Drugs have caused the number of people arrested, convicted, and incarcerated for drug-related crime to increase drastically. In 1980 there were 40,900 people incarcerated for drug offenses; by 2013, this number increased to 489,000. Considering that the vast majority of drug arrests are for possession, the criminal justice system is left to address high levels of substance abuse and addiction.

Approximately half of prison and jail inmates meet DSM-IV criteria for substance abuse or dependence, and significant percentages of state and federal prisoners committed the act they are incarcerated for while under the influence of drugs. Data from a national study in five major American cities shows that at the time of arrest, 63% to 83% of arrestees had drugs in their system, with marijuana and cocaine being the most common. Between 2000 and 2013, the percentage of arrestees with opiates in their system increased, with a couple of cities seeing significant increases in opiate presence, as well as methamphetamines.

Substance abuse and addiction have other significant public health implications; CDC data estimates that 7.6% of new HIV diagnoses between 2008 and 2011 involved transmission via injection drug use, and sharing needles and other equipment used to inject drugs is the most common form of Hepatitis C transmission. Substance abuse may be compounded by co-occurring mental illness, and many begin to use substances to cope with mental illness or physical pain.

Most people with substance abuse issues who are released from prison/jail relapse in the community. The period of incarceration provides an opportunity to connect an often hard-to-reach and under-served population to treatment while in a relatively stable setting. However, substance abuse and addiction treatment is not widely available for incarcerated individuals. The National Center on Addiction and Substance Abuse at Columbia University estimates that only 11% of incarcerated individuals in need of substance abuse treatment receive it in jail or prison.

References

Binswanger, I. A., Nowels, C., Corsi, K. F., Glanz, J., Long, J., Booth, R. E., & Steiner, J. F. (2012). Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors. Addiction Science & Clinical Practice, 7(1), 3. doi:10.1186/1940-0640-7-3.

Mumola, C.J., & Karberg, J.C. (2006). Drug Use and Dependence, State and Federal Prisoners, 2004. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Behind Bars II: Substance Abuse and America’s Prison Population. (2010). The National Center on Addiction and Substance Abuse at Columbia University.

Drug Policy. (2015). The Sentencing Project.

The items included below are a list of recent, more in-depth articles that take the reader deeper into the subject area. The list is neither comprehensive nor exhaustive, but is intended to help a reader dive deeper into the subject matter at hand. We will be updating articles on a monthly basis.

Gender as a Moderator in Predicting Re-Arrest Among Treated Drug-Involved Offenders
Yang Y, Knight K, Joe GW, et al. J Subst Abuse Treat. 2015 Feb.
“The primary aim of the current study is to explore gender differences on the relationships of pre-treatment risk factors and psychosocial functioning with time to re-arrest following termination from prison. The sample consisted of 384 males and 313 females who were admitted to four prison-based substance abuse treatment programs. Results showed that female inmates experienced a longer time to re-arrest than male inmates. Higher self-reported ratings of decision making confidence and peer support were associated with a lower likelihood of re-arrest for males. Males with higher self-esteem ratings were more likely to be re-arrested than males who reported lower self-esteem. Females with more self-reported criminal involvement had a higher rate of re-arrest than did those with less criminal involvement. In contrast to males, females with relatively high self-reported self-esteem had a lower rate of re-arrest than their counterparts who reported low self-esteem. Clinical implications include the importance of enhancing decision-making confidence and peer support for males and self-esteem for females.”

The association between impulsivity and alcohol/drug use among prison inmates
Bernstein MH, McSheffrey SN, van den Berg JJ, et al. Addict Behav. 2015 Mar.
“Background: Few studies have examined the relation between impulsivity and drug involvement with prison inmates, in spite of their heavy drug use. Among this small body of work, most studies look at clinically relevant drug dependence, rather than drug use specifically.
Method: N = 242 adult inmates (34.8% female, 52% White) with an average age of 35.58 (SD = 9.19) completed a modified version of the 15-item Barratt Impulsiveness Scale (BIS) and measures assessing lifetime alcohol, opiate, benzodiazepine, cocaine, cannabis, hallucinogen, and polysubstance use. Lifetime users also reported the frequency of use for the 30 days prior to incarceration.
Results: Impulsivity was higher among lifetime users (versus never users) of all substances other than cannabis. Thirty day drug use frequency was only related to impulsivity for opiates and alcohol.
Discussion: This study extends prior work, by showing that a lifetime history of non-clinical substance use is positively associated with impulsivity among prison inmates. Implications for drug interventions are considered for this population, which is characterized by high rates of substance use and elevated impulsivity.”

Disciplinary Responses to Misconduct Among Female Prison Inmates With Mental Illness, Substance Use Disorders, and Co-Occuring Disorders
Houser K, Belenko S. Psychiatr Rehabil J. 2015 Feb 9.
“Objective: Most female inmates have mental health, substance use, or co-occurring disorders (CODs), which can create greater difficulty adjusting to incarceration and higher rates of prison misconduct. The response of prison officials to institutional misbehaviors has important implications for female inmates’ experiences while incarcerated, their likelihood of parole, and the clinical course of their condition. This article examined whether disciplinary actions are more severe for women with CODs.
Method: Data were provided by the Pennsylvania Department of Corrections for all female state prison inmates incarcerated between January 1, 2007, and July 30, 2009 (N = 2,279). The final sample of 211 women included those who had committed a minor misconduct during their incarceration. Disorder categories were created based on intake assessments, and multivariate models were estimated to determine the effect of disorder category on whether the prison imposed a severe or minor disciplinary response to the misconduct.
Results: The odds of receiving severe disciplinary responses to minor misconduct was significantly greater for women with CODs than those with the singular disorders of mental illness or substance abuse disorders, or those with no disorders.
Conclusions and Implications for Practice: Findings suggest correctional institutions are responding in a punitive manner to the symptomatic manifestations of CODs in female inmates. These findings suggest the importance of screening instruments in correctional settings that assess for the presence of dual disorders. In addition, correctional administrators must implement training protocols for correctional officers and staff on the complexity of CODs and the ability to identify behavioral and emotional symptoms associated with this vulnerable subset of the offender population.”

Mental Health and Substance Abuse Service Engagement by Men and Women During Community Reentry Following Incarceration
Begun AL, Early TJ, Hodge A. Adm Policy Ment Health. 2015 Feb 8.
“Individuals reentering the community following incarceration are at high risk for experiencing mental health and substance use problems. This longitudinal study explores patterns and barriers for engaging treatment services during early reentry. Seventy-five men and 62 women in jail, prison, or community based correctional facilities (CBCFs) participated in pre- and post-release interviews. Findings indicate that services were engaged at a lower-than-needed rate and barriers were greater for individuals leaving jails compared to prison or CBCF. Exploratory factor analysis of the barriers instrument is presented. Implications for extending service access to this population are discussed, as are future directions for research.”