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Thought Leadership

Incarceration or Treatment: The Wrong Question

The debate over incarceration versus treatment for alcohol and drug offenders is not a new debate, but it is nonetheless a timely and significant issue. There is a fundamental disagreement in our society about which outcome is more effective, what justice looks like for various crimes, and what constitutes addiction and recovery.

As the President and CEO of a leading non-profit provider of addiction treatment, I do not believe there should be a debate between incarceration versus treatment. The question shouldn’t be what’s more effective. Everyone suffering from the disease of addiction deserves treatment, just as a patient with heart disease would be entitled to cardiac care. By understanding addiction as a disease and acknowledging that treatment is the most effective way for those suffering to recover, the solution to have addiction treatment incorporated into the criminal justice system is clear. The right question should be: What is the best way to help everyone in need of addiction treatment?

NIDA suggests multiple ways in which this can be accomplished, including: treatment as a condition of probation, treatment in prison followed by community-based treatment after discharge, treatment under parole or probation supervision, and drug courts that blend judicial monitoring and sanctions with treatment. These options take into consideration that incarceration may not be the right solution for addicts who have engaged in criminal behavior, but are not a threat to society. In many cases, an addict in a non-prison residential treatment facility will thrive in a way that would never happen in prison.

I do not believe this approach is a “get out of jail free” card for those who commit serious crimes, such as drug trafficking, larceny, murder, sexual assaults and the like. It should not be a way to skirt the justice system without punishment. My position is about the transformative power of treatment; the ability to separate the active addiction from the actual person and the potential for that person to impact society in a much more positive way if he or she receives the behavioral support so desperately needed. There is no doubt our country would benefit by having more individuals and their families receive treatment.

Let’s review some important facts about incarceration:

  • Federal prisons are operating at nearly 40 percent above capacity, according to the Department of Justice.
  • In 2009 about half (51 percent) of Federal prisoners, who represent 13 percent of the total prison population, had a drug offense as the most serious offense, according to NIDA
  • Between 1996 and 2006, as the U.S. population rose by 12%, the number of adults incarcerated rose by 33% to 2.3 million inmates. 1.5 million (65%) of the 2.3 million inmates incarcerated in our prisons and jails met the DSM-IV medical criteria for addiction, according to CASAColumbia.
  • Most inmates who need treatment don’t receive it. Only 11% of all addicted inmates receive any treatment during their incarceration, according to CASAColumbia.
  • More than half of juvenile or youthful offenders incarcerated in state prisons and local jails meet medical criteria for addiction involving alcohol or other drugs, according to CASAColumbia.

Now, let’s talk about addiction and treatment. Addiction is a chronic, progressive brain disease. In addition to genetics, which are one contributing factor to the disease of addiction, many people suffer from some kind of childhood trauma or co-occurring disorders, such as depression or anxiety, and turn to substances as a coping mechanism, which then turns into addiction. Through the use of substances, the neural pathways in the brain change. This has been scientifically proven. “Brain imaging technology has demonstrated that addiction is a brain disease by delineating profound disruptions in the specific brain circuits affected by addiction. Repeated drug exposure ‘resets’ these circuits toward compulsive behavior so that a person’s control over the desire to seek and use drugs is compromised, despite devastating consequences,” states the National Institute of Health.

Proper addiction treatment addresses both the substance addiction as well as any co-occurring disorders. Through abstinence and holistic treatment, a person’s brain is able to slowly heal allowing the neural pathways to mend and rational thought to return. Treatment allows people suffering from addiction to recover and heal. Recovery is not only powerful, but life-changing. This is something I’ve not only witnessed by engaging with the thousands of alumni Caron has treated over the years, but it’s also something I’ve experienced and can attest to firsthand.

With 65% of inmates incarcerated in our prisons and jails between 1996 and 2006 meeting the DSM-IV medical criteria for addiction, it is clear that a change needs to be made. Comprehensive clinical treatment is the best form of rehabilitation for those suffering from addiction. Scientific research corroborates this fact. According to NIDA, scientific research shows that treatment can help many drug using offenders change their attitudes, beliefs, and behaviors; avoid relapse. Additionally, NIDA has stated that treatment can cut drug use in half, decrease criminal activity, and reduce arrests.

While some individuals are fortunate enough to have a judge who understands the benefits of treatment, not all judges do. This is why drug courts are important. Drug courts are seeing firsthand the impact treatment can make. Here are some facts from the National Association of Drug Court Professionals:

  • Drug Courts significantly reduced re-arrest or reconviction rates by an average of approximately 8 to 26 percent, with the “average of the averages” reflecting approximately a 10 to 15 percent reduction in recidivism.
  • Approximately three quarters of the Drug Courts (78%) were found to have significantly reduced crime, with the best Drug Courts reducing crime by as much as 35 to 40 percent.
  • Net economic benefits to local communities range from approximately $3,000 to $13,000 per Drug Court participant.
  • Longer tenure in substance abuse treatment (Simpson et al., 1997) predicts better outcomes and Drug Courts are proven to retain offenders in treatment considerably longer than most other correctional programs.

As we see with drug courts, not only can treatment make a difference for those convicted of a crime, it can also be beneficial for the economy. According to Gary Zarkin, Ph.D., vice president of the Behavioral Health and Criminal Justice Research Division at RTI, “With greater investment in substance abuse treatment before and after release, states would save approximately $17 billion in criminal justice system costs, which includes the costs of arrests, trials, incarceration and treatment.”

Recovery has significant benefits to society. The impact of understanding addiction as a disease allows those suffering to get help, reduces crime, and boosts the economy. Treatment allows families to heal and helps break the cycle of trauma that perpetuates addiction and in some cases criminal behavior. It’s time to end the debate about incarceration versus treatment and instead focus on the best ways in which everyone suffering from addiction is able to get the help they need. We will be a better and stronger country if we invest in the solution of transforming the lives of addicts and their families and not focusing solely on locking them away.

Featured Staff
President & CEO
A strong advocate for both research and prevention, Doug Tieman has spent 30 years in the addiction treatment field.