Drug offenders have among the highest recidivism rates of all prisoners. According to the Bureau of Justice Statistics, 76.9% of drug offenders get arrested for a new crime within five years of their release. That’s a lower recidivism rate than for property crimes (82.1%) but higher than for public order offenses (73.6%) or violent offenses (71.3%).
Although jails typically don’t offer drug treatment, many state prisons do—but the above data is for state prisons. So what’s going wrong? Why isn’t prison drug treatment working?
There’s no easy answer to that question. However, a prison drug counselor, a drug policy expert, and two former inmates did their best to answer it by offering to identify what they see as some of the current problems with prison drug treatment:
1. Treatment is not offered soon enough.
Many county jails don’t offer any treatment, so inmates typically have to wait until they get to state prison until they get treatment. For some inmates, though, it’s a much longer wait than that.
“If you have some percent come in with drug problems, they still don’t get the treatment for 10 years and three dirty urines and two years in the box [solitary confinement],” said Will, a former New York State prisoner who asked only to be identified by his first name.
What Will is alluding to is the fact that inmates with shorter sentences necessarily get priority when it comes to placement in the state’s 90-day drug treatment program. As a result, those with longer terms typically have to wait—sometimes for years—before there’s room.
Although that makes sense in terms of logistics and scheduling, it’s problematic in terms of addiction and recovery.
2. After treatment, prisoners are returned to general population.
This can be a problem because it means that people who have begun taking steps toward recovery are regularly mixing with people who may still be more interested in living a criminal lifestyle.
That’s one of the problems that Frank, a prison drug counselor who asked to have his name changed to avoid losing his job, sees in New York facilities.
In the Empire State, Frank explained, there is one state facility that is dedicated entirely to housing inmates involved in drug treatment programs. That would be ideal for all prison drug treatment programs—but it would still leave a problem as far as where to house recovering addicts who have completed treatment, he said.
“I have someone on my unit that has five years left—why send them back to general population? When you put them back in GP, anything that you’ve gained you lose because you’re with people who know nothing about treatment,” he said.
Seth Ferranti, who served more than two decades in federal prison, concurred. While behind bars, Ferranti completed a 10-month Residential Drug Abuse Program (RDAP). He said, “RDAP worked like this: you finished the program, graduated, and went to [a] halfway house, so you took the program at the door. That is how it should work because it is counterproductive to put someone who just went through the program back in a harmful environment that can lead to relapse.”
3. The staff aren’t necessarily helpful.
Both Ferranti and Frank said that a lot of the staff just don’t care or are overworked – and that can make meaningful treatment difficult.
“Everyone is just trying to do their job and go home and if you are seriously trying to recover you need a good support network in prison and out,” Ferranti said. “The idea and theories are good but the practice isn’t.”
One of the problems that Frank sees in New York is that it’s really difficult to fire incompetent or under-performing counselors. They’re state jobs.
“You could be a pretty fucked-up counselor and not get fired,” he said.
4. Not everyone wants to get help.
This is perhaps to be expected in a prison treatment environment—and it’s something that is true in a lot of court-mandated treatment environments—but it’s definitely a problem.
“I got a good experience out of the program because I wanted to come back to society,” said Ferranti. “I wanted to be prepared but prison is a hard place to carry that type of attitude. I had been in a long time and prisoners respected me so I could carry it how I wanted but someone fresh into prison and trying to change is going to have a hard time with all the peer pressure and politics.”
5. Lack of opioid replacement therapy options.
Typically, jails and prisons do not offer opioid replacement therapy. Some offer the short-term use of methadone or Suboxone for detox purposes, but even that is rare. Suboxone or methadone maintenance is nearly unheard of, which is particularly unfortunate considering that some doctors consider it the standard of care for treating opiate addiction and preventing relapse.
“When it comes to treatment for people who have been addicted to heroin or other opiates, making available [Suboxone or methadone] maintenance is pivotally important,” said Ethan Nadelmann, executive director of the Drug Policy Alliance. “There’s very good research about it out there. It is standard operating procedure in many other countries around the world. Unfortunately, there are virtually no prison systems that allow it in the U.S.”
6. Placement in the program is often based more on crime than need.
In New York prisons, placement in treatment is typically mandated for drug-related crimes, whether or not the individual has a drug problem.
Will said that he still got something out of the program, but wouldn’t describe himself as someone who necessarily needed drug treatment in the first place.
“They’re putting you in based on your crime and your record,” he said. “If you didn’t cop to some kind of addiction they were basically going to kick you out.”
From a counselor’s perspective, that can be problematic.
“Sometimes we’re getting people that didn’t use but sold,” Frank said, “and it’s very hard because they can’t relate.”
7. There is very little positive reinforcement.
Frank said that, in New York, the prison drug treatment programs are based on the therapeutic community model, which relies on modifying behavior using consequences and rewards.
“TCs believe in consequences, but they also believe in rewarding people if they do good. They used to be able to have [a] pizza party or movie nights, but we can’t anymore. So we can punish them but we can’t reward them.
“Now, the best we can do is let them take a day off group. You’ve got to have rewards—that’s what TCs are based on, consequences and rewards.”
8. Fundamentally, the treatment is part of a punishment.
“I don’t believe that there’s any time that you can prescribe therapy as a punishment and have it be truly therapeutic,” Will said. “As long as your incentive is not personal well-being, it’s going to be bullshit. With that said, what can the prison do? They could offer a voluntary program.”
Frank concurred: “Prison is not conducive to helping people change.
“It’s a proven fact that prison doesn’t do anything for drug addiction—nothing. Then when they come back they’re recidivists. If you say prison is for punishment, fine. But if you say it’s so people don’t come back then you’ve got to do something so they don’t come back.”
This story was originally published on The Fix.