Most Substance-Abusing Inmates Fail to Get Adequate Treatment

Fewer than 10 percent of adult and 20 percent of juvenile offenders in the United States receive evidence-based treatment for substance abuse problems, according to the results of the National Criminal Justice Treatment Practices Survey, published in the April Journal of Substance Abuse Treatment.

Furthermore, the survey found that of an estimated 7.8 million offenders in state and local jails or prisons, 5.6 million are in need of comprehensive substance abuse treatment, but the current system can provide this level of treatment to only 430,000 offenders due to a lack of trained staff or treatment services.

Data on youth show that of the 660,000 young people in the criminal-justice system, an estimated 253,000 are in need of substance abuse treatment, and yet only 131,660 receive an adequate level of such services.

The survey included responses from 170 correctional-agency executives, 168 clinical directors and coordinators, 647 administrators and substance abuse treatment directors, and 1,085 staff members of correctional agencies, which included prisons, jails, parole and probation agencies, community correctional agencies, and juvenile detention centers.

The researchers estimated the number of adults and juvenile offenders in the criminal-justice system by extrapolating data from the survey and using data from other sources, such as the National Institute on Drug Abuse (NIDA), to estimate treatment need among offenders.

“We need a national strategy that will increase the proportion of offenders receiving evidence-based substance abuse treatment services,” Faye Taxman, Ph.D., lead author of the study and a professor in Virginia Commonwealth University's School of Government and Public Affairs, told Psychiatric News.

The survey found that in addition to a dearth of substance abuse treatment for the nation's offenders, there was also a lack of standardized assessment for substance use disorders at intake: although the majority of administrators of correctional agencies reported screening offenders for substance abuse problems at intake, less than half reported using a standardized tool to screen offenders for substance use disorders. This was true for adult and juvenile corrections facilities.

Moreover, only 38 percent and 36 percent of administrators of prisons and jails, respectively, reported that offenders with substance abuse problems are given a referral to a community-based substance abuse treatment clinician or facility when they are released.

Juvenile residential facilities reported that about half (51 percent) of youth with substance abuse disorders are provided with referrals to a community-based provider upon release.

Taxman said the majority of correctional programs that do offer substance abuse treatment offer education-based substance abuse programs, “which are not a substitute for clinical services that can guide offenders through the behavior change process.” Approximately 74 percent of prisons, 61 percent of jails, and 53 percent of community correctional agencies offer substance abuse education, the survey found.

Evidence-based substance abuse treatment is being practiced in the nation's correctional facilities, but to nowhere near the extent needed, the researchers noted.

For example, only 62 percent of adult and 72 percent of juvenile facilities target substance use disorders that may co-exist with another mental disorder, only 62 percent of adult and 59 percent of juvenile facilities assess those who have received substance abuse treatment, and only 38 percent of adult and 42 percent of juvenile settings use cognitive-behavioral counseling.

Jeffrey Metzner, M.D., chair of APA's Committee on Judicial Action, told Psychiatric News that the Supreme Court ruled in the 1970s that medical treatment (including mental health treatment) must be provided to people in the criminal-justice system. However, he noted, the Supreme Court ruled in 1974 that there is “no fundamental right to rehabilitation from drug addiction at public expense after an individual has been convicted of a crime.”

The prevalence of people in the correctional system with substance use disorders “is a significant public health problem,” stated Henry Weinstein, M.D., chair of the Committee on Persons with Mental Illness in the Criminal Justice System.

“Since offenders are four times as likely as the general population to have a substance-use disorder, treating the offender population could measurably lower the demand for drugs in our society and reduce the crime rate,” said NIDA Director Nora Volkow, M.D., in an April press release in conjunction with the survey. According to NIDA estimates, for every dollar spent on addiction treatment, there is a $4 to $7 reduction in the costs associated with drug-related crimes.

Eric Strain, M.D., chair of APA's Council on Addiction Psychiatry, is hopeful that “as cost-benefit analyses show that there is a financial benefit to providing substance abuse treatment [to offenders], these treatments will become more thoroughly integrated into the criminal justice system.”

The National Institute on Drug Abuse funded the study.

Abstracts including data from the National Criminal Justice Treatment Practices Survey are posted at<www.sciencedirect.com/science/journal/07405472>.