Addressing Drug Addiction among Offenders


by Diana DiNitto
Distinguished Teaching Professor,
University of Texas

On November 19, 2009, Professor DiNitto had the opportunity to testify before a hearing of the United States Sentencing Commission, marking the 25th anniversary of the passage of the Sentencing Reform Act of 1984. She highlights her major points from that appearance in the following commentary.- ED.

Drug abuse and dependence pose serious problems for many Americans. As far back as the Harrison Act of 1914, U.S. laws have conflated drug addiction and crime, creating an underclass of people who are considered criminals because they have a drug addiction. To return drug addiction to a public health concern so that it can be treated appropriately, four courses of action are needed:

• Treat offenders using evidence-based practices;
• Divert individuals with drug problems from prison to treatment whenever possible;
• End discrimination against drug offenders;
• Increase community-based treatment and social welfare services.

Treat Drug Offenders in Prison and Upon Release
In 2004, 46% of those in federal prison for drug possession and 59% for drug trafficking had used an illicit drug in the month before their offense.1 Of all federal prisoners, 64% were regular drug users, and 45% met criteria for drug abuse or dependence (most met criteria for dependence). In comparison, less than 3 percent of the U.S. population meets drug abuse or dependence criteria.2 Treating drug problems should be a federal justice system priority because:

• The 75% of federal inmates who meet drug abuse or dependence criteria have a prior criminal history, compared to 57% of other federal inmates;1
• Offenders who do not receive appropriate treatment are more likely to reoffend.3

Apparently, many federal prisoners have not received the type and intensity of treatment services they need. Of those who met abuse or dependence criteria, 49% participated in some type of drug program.1 About one-third participated in drug-abuse education and one-fifth in self-help or peer counseling. Only 17% received treatment from a professional. About half of all offenders in the Nation’s jails, prisons, and probation programs have drug problems, but “less than 10 percent of adults with substance abuse problems can receive treatment on a given day.”4

Services are also critical as offenders return to the community upon release. In many ways, addiction can be compared to Type 2 diabetes, hypertension, and asthma.5 All are chronic illnesses, and relapse (nonadherence to treatment and spells of illness) is not uncommon. The Director of the National Institute on Drug Abuse stresses that addiction often requires “multiple treatment episodes,” so that individuals can “accumulate the sequential gains that ultimately result in long-term, stable control over their condition.”6

Divert People with Drug Problems from the Criminal Justice System
If drug dependence has genetic, psychological, and environmental origins, and is not by itself a moral failing or crime, then policies that encourage imprisoning so many people who have drug problems, and imprisoning them for long periods of time, should be changed. Given that nearly half (47%) of Americans have used an illicit drug at some point in their lifetime,2 drug use is more a normative, rather than a deviant experience.

In 2000, 57% of federal inmates were incarcerated for a drug offense; only 10% of all federal inmates were incarcerated for a violent offense.7 In 2007, the most serious crime of more than half (53%) of federal inmates continued to be drug offenses.8 The U.S. Sentencing Commission reports that only a very small percentage of U.S. citizens convicted of federal drug crimes was eligible for alternative sentencing, and only two-thirds of those eligible received an alternative sentence.9 More could be done to divert offenders to community-based treatment rather than prison. Studies show that “every $1 invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft.”10 The returns are even greater when healthcare savings, increased workplace productivity, and other factors are added.

End Discrimination Against Drug Offenders and Others with Drug Problems
People convicted of drug crimes are punished by the criminal justice system, and are often punished again. The welfare reform legislation of 1996 bans drug felons from receiving Temporary Assistance for Needy Families (TANF) and food stamps. States that have not opted out of this ban punish offenders and their children by leaving them with less cash and food assistance. Those working to rehabilitate themselves may need TANF, food stamps, and the associated services (e.g., employment services, childcare) these programs may offer. Drug offenders who are repeatedly singled out for discriminatory treatment may face almost insurmountable barriers to supporting themselves and their children.

The Higher Education Act (HEA) also singles out students convicted of drug crimes. Students with any adult drug possession or sale convictions can be denied federal financial aid for varying lengths of times, including forever, making it more difficult for them to engage in productive activity through a college education.

Other erosions of the social welfare system, such as denying Social Security Disability Insurance and Supplemental Security Income to those with serious alcohol and drug problems also produce negative results. For example, these erosions have been associated with increased substance use and drug crime and reductions in medical care, substance abuse, and mental health treatment.11

Increase Community-based Treatment/Services to Reduce Drug Use and Crime
Accessing adequate treatment for alcohol and drug problems can be difficult. In 2008, 37% of those who said they wanted drug abuse treatment and made an effort to get it, but did not get it, said it was because they had no health insurance or could not afford treatment.2 The current system of publicly supported drug treatment is unable to meet the need for services, especially inpatient or residential care that people with the most severe problems may need. As the United States engages in the debate over health care reform, we must insist that everyone has a source of health care that includes high-quality, evidence-based treatment for alcohol, drug, and mental health problems.

In addition to psychosocial services, medications that can be helpful to people with alcohol, drug, and/or mental health problems should be available. A new federal mental health and substance abuse parity law becomes effective in January 2010. Due to exceptions in the law and because millions of Americans have no health insurance at all, many people will still not have ready access to substance abuse treatment. In addition to treatment specifically for drug problems, many ex-offenders need services that address employment, education, family, legal, and other problems.

Another reason many do not get treatment is stigma.2 Others admit they are not ready to stop using. Many more do not get treatment because they do not perceive they have a problem or need treatment. The criminal justice system has helped people with drug problems by directing them to treatment, but only one-third of the federal drug control budget has gone to treatment and prevention.12 Two-thirds has gone to law enforcement and interdiction, though alone, these expenditures do not address drug abuse and dependence. We must do more to help individuals with drug problems obtain education, treatment, and other services they need, and to encourage scientific testing of alternatives to incarceration that can better serve people with drug problems, their families, and their communities.

Diana DiNitto is Cullen Trust Centennial Professor in Alcohol Studies and Education and a Distinguished Teaching Professor at University of Texas at Austin School of Social Work. She began her career working in substance abuse treatment services. The views expressed are strictly her own.

Her full testimony is available at http://www.ussc.gov/AGENDAS/20091119/DiNitto.pdf -ED.

References
1. Mumola, C. J., & Karberg, J. C. (2007, January 19). Drug use and dependence, state and federal prisoners, 2004. Washington, DC: U.S. Department of Justice. Retrieved November 9, 2009, from http://www.ojp.usdoj.gov/bjs/pub/pdf/dudsfp04.pdf.

2. Office of Applied Studies. (2009). Results from the 2008 National Survey on Drug Use and Health: National findings. Washington, DC: Substance Abuse and Mental Health Services Administration. Retrieved October 1, 2009, from http://oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.pdf.

3. National Institute on Drug Abuse. (2007). Principles of drug abuse treatment for criminal justice populations: A research-based guide. Bethesda, MD: National Institutes of Health. Retrieved November 9, 2009, from http://www.nida.nih.gov/PDF/PODAT_CJ/PODAT_CJ.pdf.

4. Whitten, L. (2009). Research addresses needs of criminal justice staff and offenders. NIDA Notes, 22(3), 4-5. Retrieved November 9, 2009, from http://www.nida.nih.gov/NIDA_notes/NNvol22N3/nidaatwork.html.

5. McLellan, A. T., Lewis, D. C., O’Brien, C. P., Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689-1695.

6. Volkow, N. D. (2009, October). Suiting treatment to the nature of the disease. NIDA Notes, 22(4). Retrieved November 9, 2009, from http://www.drugabuse.gov/NIDA_notes/NNvol22N4/DirRepVol22N4.html.

7. Bureau of Justice Statistics. (2007, August 8). Criminal offenders statistics. Washington, DC: U.S. Department of Justice. Retrieved October 17, 2009, from http://www.ojp.usdoj.gov/bjs/crimoff.htm.

8. West, H. C, & Sabol, W.J. (2009, May 12). Prisoners in 2007. Appendix Table 12. Washington, DC: Bureau of Justice Statistics. Retrieved November 9, 2009, from http://www.ojp.usdoj.gov/bjs/abstract/p07.htm.

9. U.S. Sentencing Commission. (2009, January). Alternative sentencing in the federal criminal justice system. Washington, DC: Author. Retrieved November 16, 2009, from http://www.ussc.gov/general/20090206_Alternatives.pdf.

10. National Institute on Drug Abuse. (2009). Principles of drug addiction treatment: A research-based guide (2nd ed.). Bethesda, MD: National Institutes of Health. Retrieved November 9, 2009, from http://www.nida.nih.gov/PDF/PODAT/PODAT.pdf.

11. For studies on this topic see Contemporary Drug Problems, 30(1/2), 2003.

12. Office of National Drug Control Policy. (2009, May). National drug control strategy. FY 2010 budget summary. Table 1. Federal drug control spending by function. (Washington, DC: Executive Office of the President). Retrieved September 27, 2009, from http://www.whitehousedrugpolicy.gov/publications/policy/10budget/index.html


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