NIDA Director Nora Volkow, M.D., discusses the importance of treating
criminal offenders for substance-abuse problems at a press conference in
Chicago in July. Not only do the inmates benefit, but so does society at large
by, for example, reduced crime and unemployment. Courtesy of NIDA
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
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
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. ▪