Substance abuse among U.S. prison inmates and rehabilitation programs

SPECIAL POPULATION & SUBSTANCE ABUSE

Special Population and Substance Abuse

Prison inmates and substance abuse

Drug courses or rehabilitation programs for drug offenders

The reoffender issue

Drawbacks of not providing rehab treatments and facilities

Cost vs. benefit analysis if rehabilitation programs and imprisonment

Drug abuse or substance abuse is a major issue in the U.S. It is the addictive and patterned use of drugs in quantities that are not approved by the health and medication regulating bodies, neither administered under the supervision of any clinician. Substance abuse covers wide categories of drugs used without the prescription of health administrators with excessive and often dangerous consumption levels. Substance abuse includes the use of performance enhancing and psychoactive drugs. The leading organizations that issue the standards and symptoms of drug and substance abuse are World Health Organization's International Statistical Classification of Diseases, American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and ICRIS Medical organization Related Health Problems (ICD). Substance abuse is a blanket term used to describe excessive and illegal use of any drug not being allowed to the user. World Health Organization (WHO) defines substance abuse as "Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use" (WHO).

The research paper is aimed to present an informed discussion on substance abuse in context of prison inmates. There are large percentages of prisoners in each U.S. state that fall within the category of substance abuse according to the DSM IV medical criteria. Section two of the paper will discuss substance abuse in context of prisoners and the current findings of leading health organizations in this regard. Section III will highlight the significance of drug courses or rehabilitation programs for drug offender inmates. Section IV will include discussion on the reoffender issue followed by analysis of rehabilitation programs in section V along with drawbacks of non-provisionof rehab treatments and facilities to inmates. Sections VI and VII shall describe the cost vs. benefit analysis of rehabilitation programs and imprisonment in the U.S. And conclusion of the paper respectively.

II- Prison inmates and substance abuse

The National Center on Addiction and Substance Abuse, Columbia University in 2010 reported that out of the total of 2.3 million inmates in the U.S. prisons, 1.5 million meet the criteria of substance abuse and addiction defined by Diagnostic and Statistical Manual of Mental Disorders (DSM) IV. The report also mentioned the presence of another 458,000 inmates having significant history of substance abuse, under influence of drugs during the crime, or incarcerated for drug abuse crimes. Thus, having combined the total population of the U.S. inmates falling within the category of substance abusers was assessed to be 85% of the total U.S. inmates in prisons (CASAColumbia, 2010). This indicates towards the graveness of substance abuse issue in the U.S. prisons and also highlights the importance of arranging for rehabilitation interventions for these inmates. A rather old study conducted on the issue of substance abuse in the U.S. prisons was that by Peters, et al. (1998) in which the authors concluded that as much as 74% of the 400 inmates being clinically assessed for substance abuse DSM-IV alcohol and drug disorders resulted positive. 46% of the total inmates that were investigated for the disorder were dependent on alcohol or drugs.

Although, conducted on a small scale, the results of the study are significant in understanding the overall trend of a sharp increase of DSM-IV substance abuse disorder in the U.S. inmates during the last one decade. The findings of Peters, et al. (1998) and those reported by Colombia University indicate the same. Fazel, Bains and Doll (2006) also conducted a study in which systematic review was performed of studies already carried out on prevalence of drug and substance abuse in the U.S. inmates. The results were somewhat different as less disturbing as compared to the findings of Colombia University and Peters, et al. (1998).13 studies were being reviewed in which 7563 prisoners met review criteria.

For male inmates, substance and alcohol abuse was reported to have ranged between 18 to 30% whereas for female inmates it was 10 to 24%. The authors suggested that screening tests should be conducted at the time of prison admission whereas to curb the substance abuse addiction, treatment during custody should be offered along with follow-up on releasing the inmates. The three studies being reviewed suggested improvement in treatment capacity of prisons to reduce the staggering percentage of DSM-IV substance abuse disorder in special populations of the U.S. prisons.

IV- The reoffender issue

The issue of re-offending in inmates relapsing to drug and substance abuse is also significant in order to deal the issue in totality. The issue of re-offending is significant as many governments of the world are striving to address the challenge of decreasing re-offend rates. The government of New Zealand also published a report in 2010. The study by NSW Justice Health indicated that inmates having substance abuse disorders along with non-substance disorder were likely to re-offend due to the complexity of their issue, mental and physical. "After adjustment for demographic and criminal history characteristics, the rate of re-offending among prisoners who had co-morbid substance and non-substance mental health disorders was 67 per cent, compared with 55 per cent among prisoners who had only a substance disorder" (Smith & Trimboli, 2010; Pg. 1). The findings suggest that the value of investments in treatment and rehabilitation programs of inmate substance abusers is high and to prevent high rate of re-offending, the federal and state government need to coordinate and collaborate in treatment and prevention programs. Since there are many costs involved after the inmates re-offend, much emphasis has been laid on improving the treatment services and availability of services to inmates in the U.S. prisons. Remaining uneducated and unskilled is also amongst main reasons of re-offending in the U.S. inmates. Lack of solid family support is also detrimental to the cause of rehabilitation of inmates (Petersilia, 2000). Most of the paroles fail and rearrests occur within the first six months of release of inmates having substance abuse disorder. All new admissions in the U.S. prisons had staggering proportion of parole failures, from being 17% in 1991 to 35% in 2000 (Petersilia, 2000).

V- Drawbacks of not providing rehab treatments and facilities

There are a number of drawbacks related to non-provision of rehabilitation and treatment services to the substance abuse offenders. The most prominent is the re-offend rate of substance abusers and the resulting economic, social, and administrative issues being created for the state and federal government as well as counties. The U.S. has high rate of incarceration for the people involved in drug and substance abuse. It was reported in the Colombia University study of 2010 that every 8 of the 10 people involved in substance abuse are incarcerated by the government.

Despite having only one fifth of the world's population, the U.S. consumed two thirds of the illegal drugs consumed in the whole world. This indicates the high usage of substances and drugs and the resulting high ratio of incarceration by the government authorities. There are other striking findings reported in the Colombia University report regarding the rate of incarceration of U.S. inmates involved in substance abuse. The inmates being re-incarcerated and having substance abuse disorder are four times more likely to earn income from illegal activities. 41% of such inmates having drug abuse history have record of family members being involved in criminal activities. 20% of such inmates before their incarceration are also found to have been unemployed. This indicates that there are numerous issues, both physically and mentally that need to be treated in case of substance abusers in the U.S. prisons. Since these inmates are incarcerated within six months to three years of their release, this puts extra burden on the tax payers as tax-payer money is used to cater and meet the living needs of these inmates. In contrast, only if effective treatment facilities and rehabilitation programs such as those administered in the State of California are introduced in all the states, there can be considerable saving of tax-payer funds. Human resources and administrative costs of managing these substance abusers will also be reduced in community-based treatment facilities as compared to prisons. The correctional programs help reduce the criminal activities of offenders. Other areas of the offender's life have to be included in the treatment programs, such as employability, mental health, spouse relationships, and relationship with social connections.

VI- Cost vs. benefit analysis if rehabilitation programs and imprisonment

MacKenzie and Hickman (2006) outlined the costs and benefits of implementing an effective prevention and treatment program for the substance abusing inmates. The report was widely acclaimed for the sound recommendations it provided for controlling the costs of managing inmates with substance abuse records. The report recommended that most sound efforts that have effectively served the purpose of treatment were drug courts, educational programs, and intensive supervision of inmates during the rehabilitation phase. The study utilized the Maryland Crime Prevention Report and conducted Meta analyses of existing studies on prevention and treatment of substance abuse offenders. The authors also suggested that by relying on the theory of cognitive transformation, the practitioners can improve the results of their efforts in treating substance abusers in prisons. The study also emphasized on preventing the offenders from re-offending by eliminating the enabling environment that these substance abusers get for executing their activities. The most prominent benefit that fulfills the cost of treatment and intervention programs is that by not having to spend huge sums of money on managing the U.S. prisons inundated with scores of substance abusers that otherwise could have been provided with conciliatory services to rehabilitate them.

The Gadsden County Jail near Tallahassee, Florida houses 250 inmates as opposed to a capacity of 150. This was reported by CBS news and attributed the figures to president of the International Association of Chiefs of Police, Walter McNeil (Teichner, 2012). According to the coercive mobility hypothesis, the mass incarceration increases the probability of crimes by reducing the impact of informal social controls. Once the informal social controls are withered away due to mass incarceration, overall destabilization increases in the area where incarcerations are frequent (Clear, 2007).

VII- Conclusion

The addictive and patterned use of substances in quantities and forms not legally allowed or administered by clinicians is known as the substance abuse. American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) manages and publishes the criteria of substance abuse disorder. In context of special populations, out of total 2.3 million U.S. inmates, 1.5 million were reported to have been the casualty of substance abuse disorder, according to DSM criteria. Approximately 74% to 85% of the U.S. inmates were found to be substance abusers in two different studies. These studies were conducted by different authors and with a gap of 12 years between them. This indicates towards the magnitude of substance abuse issue in context of inmates. In order to address the issue, the U.S. Federal Bureau of Prisons had initiated treatment and rehabilitation programs such as Residential Drug Abuse Program (RDAP) and Community Transition Drug Abuse Treatment (TDAT). The contribution of U.S. Drug Courts has also been significant in treating the inmates having substance abuse disorder. The benefits of treatment, preventions, and rehabilitation programs for substance abusing inmates are significant and are more than the costs of such programs.