Behind Bars II: Substance Use and America’s Prison Population

BEHIND BARS II:
SUBSTANCE USE AND
AMERICA’S PRISON
POPULATION
A Report by
CASAColumbia®

February 2010

Purpose of Study
• Define size and characteristics of prison population—particularly
substance-involved offenders
• Identify promising practices to reduce substance-related crime and
its costs

• Assess costs and benefits of providing treatment

© CASAColumbia 2013

2

Reviewers
• Steven Belenko, Ph.D., Professor of Criminal Justice, Temple
University
• James R. McDonough, former Director of Strategy, White House
Office of National Drug Control Policy, and former Secretary, Florida
Department of Corrections

• Faye S. Taxman, Ph.D., Professor, Administration of Justice, George
Mason University


3

Methodology
• Analyzed 11 federal data sources on offenders

• Reviewed > 650 articles/publications
• Examined practices in prevention, intervention and treatment for
substance-involved offenders

• Reviewed accreditation standards
• Analyzed costs and benefits of treatment for offenders with
substance use disorders


4

Substance-Involved Offenders
• Had history of using illicit drugs regularly or of alcohol treatment

• Met medical criteria for alcohol and/or other drug abuse and/or
dependence
• Were under the influence of alcohol or other drugs at time of crime

• Committed crime to get money to buy drugs
• Were incarcerated for an alcohol or drug law violation, or
• Shared some combination of these characteristics


5

Key Findings
• Only 11% get treatment

• In 2006, 85% (1.9 million) inmates substance-involved
• 65% (1.5 million) inmates meet medical criteria for a substance use
disorder

• Failure to prevent and treat addiction in the justice system increases
crime and government costs


6

Growth in Inmate
Population 1996-2006
Substance-Involved Inmate Population Increasing
Faster Than U.S. and Total Inmate Populations
43.2

32.8

12.5

% Increase in US
Population

% Increase in US Inmate
Population

% Increase in US
Substance-Involved
Inmate Population

Source: CASA analysis of U.S. Census Bureau (2000 and 2008); CASA analysis of the Survey
of Inmates in Federal Correctional Facilities (1991 and 2004), Survey of Inmates in State
Correctional Facilities (1991 and 2004), Survey of Inmates in Local Jails (1989 and 2002)
[Data files], and U.S. Bureau of Justice Statistics Reports, Prisoners in (1996 and 2006).


7

Substance-Involved Inmates
Total
Federal Prison
State Prison
Local Jail
Total


190,884
1,302,129
766,010
2,258,983

2006
Substance
Involved
164,521
1,101,779
648,664
1,914,964

% Substance
Involved
86.2
84.6
84.7
84.8

8

Inmates by Type of Crime
Percent of Federal, State and Local Inmates
by Type of Crime Committed
37.0
29.2
19.2

13.3

Violent

Alcohol/Drug

Property

Other

Source: CASA analysis of the Survey of Inmates in Federal Correctional Facilities
(2004), Survey of Inmates in State Correctional Facilities (2004), Survey of Inmates in
Local Jails (2002) [Data files], and U.S. Bureau of Justice Statistics Reports, Prisoners
in 2006.
Note: An additional 1.3% of Inmates committed crimes that were not specified.

9

Inmates Committing
Violent Crimes
Percent
77.5
57.7

Substance Involved

Alcohol Involved

(2004), Survey of Inmates in State Correctional Facilities (2004), Survey of Inmates
in Local Jails (2002) [Data files], and U.S. Bureau of Justice Statistics Reports,
Prisoners in 2006.


10

Inmates Committing
Property Crimes
Percent
83.4
55.9

Substance Involved

Alcohol Involved

Prisoners in 2006.


11

Inmates Committing
Other Crimes
Public Order, Immigration or Weapons
Offenses or Supervision Violations
Percent
76.9
51.6

Substance Involved

Alcohol Involved

Prisoners in 2006.


12

Few Incarcerated for Marijuana
Possession Only
Percent of Inmates
2.0
1.1

Total

0.9

Marijuana Possession as Marijuana Possession as
Controlling Offense
Only Offense

Prisoners in 2006.


13

Tobacco Use High
Among Inmates
Percent Current Smokers
66.5
51.5

38.6

37.8

Federal*
Inmates

Federal*
State* Inmates State* Inmates
Inmates with
with Substance
Substance Use
Use Disorders
Disorders

24.9

General
Population

* Smoked in month before arrest.

(2004) and Survey of Inmates in State Correctional Facilities (2004) [Data files];
Substance Abuse and Mental Health Service Administration (2006).


14

Substance Use/
Mental Health Disorders
Percent of Inmates
64.5
32.9

Substance Use Disorders

24.4

Mental Health Disorders

Co-Occurring Substance
Use and Mental Health
Disorders
Prisoners in 2006.
Inmates 7 times likelier to have an alcohol/other drug disorder than general population.


15

Substance-Involved
Inmates Are:
• 41% likelier to have family w/criminal history (43% vs. 30%)

• Almost twice as likely to have had at least one parent abuse
alcohol/other drugs (35 vs. 18%)
• 29% less likely to have at least a high school education (30% vs.
39%)
…than inmates who are not substance involved


16

Criminal Careers
Substance-involved inmates likelier than non-substance involved
inmates to:

• Begin criminal careers at earlier age
• 4 times likelier to receive income through illegal activity
(25% vs. 6%)

• Have more contacts with the criminal justice system
• Be re-incarcerated for another offense (52% vs. 31%)


17

Inmate Parents
• U.S. inmates are parents to > 2.2 million minor children

• 74% of inmate children (1.7 million) are age 12 or younger
• Minor children of incarcerated parents at much higher risk of:
 Juvenile delinquency
 Adult criminality
 Alcohol/other drug use
…than minor children of non-incarcerated parents


18

Substance Use
Disorders Among Inmates
By Race
• 73%

White (non-Hispanic)

• 70%

Native American

• 60%

Black (non-Hispanic)

• 58%

Hispanic

• 51%

Asian, Hawaiian, Pacific Islander, Other


19

Women Inmates
• 8.4% of inmate population

• Compared with male inmates, female inmates have
higher rates of:
 Substance use disorders (66% vs. 64%)
 Mental health disorders (55% vs. 31%)
 Co-occurring disorders (41% vs. 23%)


20

Women Inmates
Compared with male inmates, female inmates:
 Almost 4 times likelier to have been physically abused before
incarceration
 58% likelier to have ever been homeless

 31% likelier to have had parents/guardians who abused
alcohol/other drugs


21

Other Health Conditions
• 60% age 12 and over with FASD have been involved with
justice system
• 19% of veteran inmates have PTSD vs. 7% non-veteran inmates
• Inmate vs. general population:
 Almost 3 times rate of HIV
 6-7 times rate of Hepatitis C


22

The Treatment Gap
• 1.5 million inmates with substance use disorders

• 11% receive treatment
• Nicotine dependence rarely addressed
• Very little treatment is evidence-based


23

Inmate Participation in
Support Services
• Of inmates with substance use disorders:
 23% participated in mutual support/peer counseling

 14% received drug education

• Of all substance-involved inmates:
 56% participated in religious/spiritual activities


24

Inmates in Education/
Vocational Programs
Percent
67
57

1996

57

2006

45

14

Federal Prisons

State Prisons

12

Local Jails

Source: CASA analysis of the Survey of Inmates in Federal Correctional Facilities (1991
and 2004), Survey of Inmates in State Correctional Facilities (1991 and 2004), Survey of
Inmates in Local Jails (1989 and 2002) [Data files], and U.S. Bureau of Justice Statistics
Reports, Prisoners in (1996 and 2006).


25

Professional Standards for
Treating Inmates
• American Correctional Association in cooperation with Commission
on Accreditation for Corrections (1990)
• National Institute of Corrections (1991)
• Center for Substance Abuse Treatment (1993 and updates)

• Substance Abuse and Mental Health Services Administration (2004)
• National Institute on Drug Abuse (2006)
ALL Standards except SAMHSA 2004 are voluntary


26

Essential Elements of
Best Practice
• Screening and comprehensive assessment

• Treatment for substance use and co-occuring health/mental health
disorders
• Aftercare

• Monitoring/rewards/sanctions


27

Treatment/Aftercare Can
Reduce Recidivism
• Delaware: 5 year re-arrest rates—52% prison-based
treatment/aftercare vs. 77% control group
• California: 1 year re-incarceration rates—8% prison-based TC
treatment/aftercare vs. 50% control group
• Illinois: 52% lower likelihood of re-incarceration for prison-based
treatment/aftercare vs. comparison


28

Diversion Programs
Reduce Recidivism
• Prosecutorial-based Diversion (DTAP)—graduates at 2 years
were 87% less likely to return to prison than matched group at half
the cost of incarceration
• Drug Courts—all programs tracking costs and savings showed
positive net benefits

• DUI Courts—3 times less likely to be rearrested; 19 times less likely
to be rearrested for a DUI compared with traditional probation
• Probation (Hawaii)—targeting offenders at high risk of probation
revocation; re-arrest rates 3 times lower than comparison group


29

Costs and Benefits of Treatment
• Average cost of comprehensive prison-based treatment and
aftercare—$9,745 inmate
• Providing these services to all inmates in need would pay for itself in
1 year if less than 11% remain substance-and crime-free and
employed

• Each additional year yields economic benefit of $90,953 per inmate
• Sharp reductions in crime


30

Recommendations for the
Criminal Justice System
Use appropriately trained health care professionals to:
• Screen, assess and treat with evidence-based approaches
• Provide comprehensive support services
• Provide pre-release planning and reentry services
• Expand use of treatment-based alternatives to incarceration


31

Recommendations for Federal,
State and Local Governments
• Require that addiction treatment be provided in criminal justice
settings; that it be medically managed; and that behavioral and
pharmacological treatments be available
• Require accreditation of prison- and jail-based treatment programs
and providers


32

Ending Addiction
Changes Everything

www.casacolumbia.org


Speaker Notes
Slide 2:
•

The purpose of this study was to:
• Identify just how many alcohol and other drug-involved inmates are in our prisons and jails
• Provide as much detail as possible on the characteristics and treatment needs of those
offenders
• Identify promising practices to address this problem
• Examine the costs and benefits of providing treatment--either to incarcerated offenders or as
alternatives to incarceration

Slide 5:
•

Our study focused on substance-involved offenders, defined as meeting one or more of the
following criteria:
1. Had history of using illicit drugs regularly or of having received alcohol treatment
2. Reported meeting medical criteria for alcohol and/or other drug abuse or dependence (a substance use
disorder defined in the DSM-IV)
3. Were high on alcohol or other drugs at time of their crime—this could be drugs like methamphetamine,
cocaine, heroin or controlled prescription drugs.
4. Committed their offense to get money to buy drugs, or
5. Were imprisoned for an alcohol law violation (such as illegal manufacture, or transport or driving under the
influence) or a drug law violation (such as possession, sale, distribution).


34

Speaker Notes
Slide 6:
•

•
•
•

85% of all adult inmates in federal, state and local prisons and jails are substance involved--1.9
million of the 2.3 million inmates in 2006. Our earlier report found that 79-80% were substance
involved in 1996 or about 1.7 million inmates.
Almost 2/3 of all inmates--1.5 million--report meeting medical criteria for a substance use disorder.
In spite of evidence of cost effective interventions, only 11% of those with such disorders receive
anything even called professional treatment.
Our nation’s continued failure to provide these needed health care services visits crime on society
and imposes staggering yet preventable costs to taxpayers.

Slide 7:
•
•

The U.S. substance-involved inmate population has grown at more than 3 times the rate of the
general population.
Even faster than the inmate population itself.


35

Speaker Notes
Slide 8:
•
•
•
•
•
•

America has the highest incarceration rate in the world.
With less that 5% of the world’s population, we have almost 1/4 of the world’s prisoners.
This slide shows where these prisoners are housed.
Most inmates--1.3 million of them – are in state prisons where more than 84% are substance
involved.
Another 766,000 are in local jails where about the same percent are substance involved.
Federal prisons house the fewest offenders--about 191,000--but have the highest percent of
substance-involved offenders.

Slide 9:
•
•
•
•
•
•

This slide shows inmates by the types of crimes they are incarcerated for as their controlling or
most serious offense.
Much attention has been focused on those incarcerated for drug law violations.
But the largest group of inmates--37%--are incarcerated for violent offenses.
The combination of alcohol and other drug law violations are the controlling offenses of 29% of the
inmate population.
Inmates incarcerated for property offenses equal about 1/5 of the inmate population and
Another 13% are there for other offenses including public order, immigration and weapons
offenses and supervision violations.


36

Speaker Notes
Slide 10:
•
•
•
•

Substance involvement permeates all types of crime.
Among those incarcerated for violent offenses, 78% are substance involved.
While illegal and controlled prescription drugs are involved in 3/4 of the substance-involved crime,
alcohol is a factor in over 1/2 of all inmate crimes.
58% of inmates incarcerated for violent crimes are alcohol involved, meaning that the inmate was
either:
• Under the influence of alcohol at the time of the crime
• Had a history of alcohol treatment
• Had an alcohol use disorder, or
• Committed an alcohol law violation

Slide 11:
•

Of inmates incarcerated for property offenses as their most serious crimes:
• 83% of them are substance involved
• 56% are alcohol involved


37

Speaker Notes
Slide 12:
•

•

Among those incarcerated for other offenses--the public order, immigration or weapons offenses
or supervision violations:
• 77% are substance involved
• 52% are alcohol involved
The remaining category of offenses is alcohol and drug law violations. By definition, 100% of
inmates committing these offenses are substance involved.

Slide 13:
•

Marijuana is involved in many crimes of inmates, but contrary to public perception, only 2% of
inmates are incarcerated for a marijuana offense as their controlling or only offense. This includes
possession, trafficking and other non specified offenses.
• Only a little over 1% of inmates are incarcerated for marijuana possession as their most
serious offense and
• A little less than 1% are incarcerated for marijuana possession as their only offense.


38

Speaker Notes
Slide 14:
•

Smoking rates among inmates are much higher than in the general population, particularly among
inmates with substance use disorders.
•
Smoking is both a public health concern in its own right and also is important to address since it is
related to an increased risk for relapse for alcohol use disorders.
Side Note: (Smoking rate for population as a whole 2008--25.5%)

Slide 15:
•
•
•

65% of inmates report meeting clinical criteria for substance use disorders--that is 7 times the rate
in the general population.
Another 1/3 of inmates have a mental health disorder as defined by a past diagnosis or history of
treatment
And a 1/4 have both a substance use and mental health disorder.

Slide 16:
•
•

Substance-involved inmates are likelier than those who are not substance involved to come from
families with a history of criminal activity and substance use problems
And they are less likely to have completed at least high school.


39

Speaker Notes
Slide 17:
•

Substance involved inmates are likelier:
• To start committing crimes at younger ages
• To have earned money illegally
• To come into contact with the criminal justice system more frequently, and
• To be re-incarcerated
than non-substance involved inmates.

Slide 18:
•
•
•
•
•

Inmates in America are parents to more than 2.2 million minor children.
About 3/4 of these children are 12 years old or younger.
These parents are, for the most part, imprisoned at considerable distance from their children and
Over half of state inmates haven’t seen their children at all since their imprisonment.
Without intervention, these children are at high risk of following in the footsteps of their parents.


40

Speaker Notes
Slide 19:
•
•

•

Minority inmates have lower rates of substance use disorders than white inmates.
Blacks and Hispanics report lower rates of drug use in the month prior to their arrest do than
whites.
Yet incarceration rates for minorities are much higher than for whites:
• 1 in 100 adults is in prison or jail, including
• 1 in 106 white men
• 1 in 36 Hispanic men
• 1 in 15 black men
• 1 in 9 black men age 20-34

Slide 20:
•
•

Women comprise 8.4% of the total inmate population--up from 7.7% in 1996.
Compared with male inmates, women are more likely to have:
• Substance use
• Mental health and
• Co-occurring substance use and mental health disorders


41

Speaker Notes
Slide 21:
•

•

Women inmates also are far likelier:
• To have been physically or sexually abused and
• To have been homeless before their incarceration
• To have come from families with substance use problems.
All of these factors are tightly linked with substance use disorders and justice system involvement.

Slide 22:
•

•
•
•
•

Caused by exposure to alcohol in utero, individuals with fetal alcohol spectrum disorder (FASD)
are at particularly high risk of justice system involvement both because of:
• Their family history of excessive alcohol use and
• The condition itself--which can includes poor impulse control, poor anger management skills
and poor judgment.
One in 10 inmates is a veteran—their rates of post traumatic stress disorder (PTSD) are almost 3
times that of non-veteran inmates and PTSD is highly correlated with substance use disorders, as
are HIV/AIDS and hepatitis C.
The infection rate among inmates for HIV/AIDS is almost 3 times that of the general population,
although progress has been made reducing these rates among inmates
Rates of hepatitis C are 6-7 times higher in the inmate population.
All of these groups require treatment for their health conditions and, for those with FASD and
PTSD, to reduce their risks of reoffending.

42

Speaker Notes
Slide 23:
•
•
•
•

•

Only 11% of inmates with substance use disorders receive any type of professional treatment, and
we have reason to be concerned about the quality of the treatment that is provided.
Few facilities offer a sufficient complement of evidence-based treatment practices such as
comprehensive assessments, behavioral and pharmacological therapies, treatment for cooccurring disorders, or assurance of effective aftercare services.
In fact, between 40-60% of prison and jail medical directors report that they don’t even know if
pharmacological therapies are appropriate for inmates.
Less than 17% of facilities offer treatment in specialized settings, which can produce the best
results
Few offer any treatment at all for nicotine dependence.

Slide 24:
•

•

More inmates receive some form of support services than receive treatment:
• Less than 1/4 of inmates with substance use disorders report participating in mutual support
or peer counseling services, including Alcoholics Anonymous or Narcotics Anonymous.
• 14% report receiving some form of drug education, and
• Over 1/2 of all substance-involved inmates report participating in religious/spiritual activities.
While these services can be important adjuncts to treatment, they are not sufficient to meet the
needs of inmates with substance use disorders.


43

Speaker Notes
Slide 25:
•
•

Since substance-involved inmates frequently lack education and job readiness, educational and
vocational services are very important to their recovery .
Unfortunately, the percent of inmates participating in these programs has declined overall from
1996 to 2006 -- particularly in federal and state prisons.

Slide 26:
•

•

•

The profound lack of appropriate treatment and support services for substance-involved inmates
is particularly difficult to understand in light of a large body of recommended guidelines and
standards for providing addiction treatment in criminal justice settings dating back almost 2
decades, developed by:
• The American Correctional Association
• And by 4 federal agencies
With the one exception of federally mandated accreditation standards for facilities that choose to
provide opioid treatment in prisons and jails--the SAMHSA 2004 standards you see here-All of these are standards and guidelines are voluntary only.


44

Speaker Notes
Slide 27:
•
•

•

•
•

Based on the research behind the development of these guidelines, we know the essential
elements of best practice for inmates
These include using trained health professionals to:
• Conduct screenings for substance related problems
• For those who screen positive, provide comprehensive assessments of their substance use,
health, mental health, job readiness, and their family and social circumstances
Provide evidence-based treatment in accordance with individualized treatment plans and
including:
• Behavioral and pharmacological therapies
• Treatment for co-occurring disorders
Patient education in disease management and the necessary education, training, family and
social supports
In the criminal justice system, it also means:
• Addressing correctional requirements
• Providing case management and integrated reentry and aftercare services
• And closely monitoring compliance using prompt rewards and sanctions.


45

Speaker Notes
Slide 28:
•
•

There is a body of evidence to show that the combination of prison-based treatment and aftercare
can reduce recividism.
Examples are Delaware, California and Illinois. All show significantly lower likelihood of re-arrest
or re-incarceration for those receiving such services compared with a control or comparison group
receiving no treatment and aftercare.

Slide 29:
•
•

Providing treatment-based diversion programs has the potential to produce even more savings
since additional court and treatment costs generally are lower than costs of incarceration.
Examples of effective treatment-based alternatives to incarceration include:
• Using a prosecutorial-based model like the DTAP program in Brooklyn, NY
• Using a drug court model or
• Intensive monitoring and treatment based probation.


46

Speaker Notes
Slide 30:
•
•

•
•

•

In every cost-benefit analysis of criminal justice-based treatments that CASAColumbia found, the
monetary benefits of treatment outweighed the costs--and the returns were striking.
According to a comprehensive review by the National Institute on Drug Abuse, the return of
investing in treatment for this population may be more than $12 for every $1 spent--as a result of
reduced substance-related criminal justice and health care costs and reduced crime. Studies have
shown that a drug using offender commits conservatively 100 crime per year.
The cost of incarceration can exceed $65,000 per inmate per year. For an investment of 1/6 of
that amount, we could recoup 100% of our costs in 1 year and sizable returns thereafter.
CASAColumbia’s own analysis found that if we provided the most intensive and evidence-based
services (prison-based treatment and aftercare) to all inmates with substance use disorders not
receiving treatment and if only 11%--a conservative estimate--remained substance-and crime-free
and employed, the intervention would pay for itself in one year and would reap over $90,000 in
benefits for each additional year the inmate remained substance-and crime-free and employed.
Investments in treatment can yield returns rarely if ever seen in any other area of public policy.


47

Speaker Notes
Slide 31:
•
•
•

We are spending billions of taxpayers dollars because we are not treating the addiction of
inmates--$74 billion per year at last count.
Addiction is a preventable and treatable health condition for which we have cost effective options
and recommended standards of practice.
Key recommendations include:
• Using trained health professionals at all levels in the criminal justice system to implement best
practices in screening, assessment, treatment, pre-release planning and aftercare
• Screening all arrestees for substance-related problems and connecting those who screen
positive with appropriate interventions and treatments
• Expanding treatment-based alternatives to incarceration

Slide 32:
•

We further recommend that federal, state and local governments require:
• That addiction treatment be provided in criminal justice settings
• That it be evidence based and medically managed
• That both behavioral and pharmacological treatments be available, and
• That prison- and jail-based treatment programs and providers be accredited to provide such
services, based on scientific standards of practice.


48

Behind Bars II: Substance Use and America’s Prison Population

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