A new report from the Prison Policy Initiative argues that jails and prisons, despite often acting as “de facto treatment facilities,” rarely provide care or treatment that people with substance abuse disorders need, and instead rely on punitive measures in failed attempts to keep drugs out of the facilities.
“This tension points to a crucial flaw in our nation’s reliance on criminalization: these institutions were never intended to be — and can never function as — healthcare providers,” the report reads. “Efforts to reverse engineer them as such have proven ineffective, harmful, and financially wasteful, substituting medical best practices with moralizing and surveillance, from providing exclusively abstinence-based education to scanning and photocopying mail in a vain attempt to keep contraband out.”
Substance abuse disorders are far more prevalent throughout the criminal legal system than they are in society, the report points out. In 2019, nationally, about 8% of people have substance abuse disorders. But 41% of people arrested met that criteria, along with 32% of people incarcerated in federal prisons, and 49% of people incarcerated in state prisons.
“The prevalence of substance use disorders at every level of the criminal legal system points to an unavoidable fact: despite the deep unpopularity of the War on Drugs, our society still responds to substance use (and related crimes) as individual failures requiring punishment, rather than as a public health problem — and it’s not working.”
In both prisons and jails, evidence based treatment options are scarce. In local jails, less than two-thirds screen for substance abuse disorders when people are admitted, and only around half provide medication for people going through opioid withdrawal. Even fewer provide behavioral or psychological treatment or medication-assisted treatment.
Instead, prisons and jails are increasingly relying on mail screening, which includes “diverting incoming letters, greeting cards, and artwork, making photocopies or digital scans of them, and delivering those inferior versions to recipients,” visitation restrictions, invasive strip searches of people who are incarcerated, and solitary confinement to combat drug use inside.
Those responses are ineffective, the report argues.
“Public health research has long been clear that punishing addiction does not actually help address substance use disorders, and there is no reason that it would work in jails and prisons. People who need mental health and substance use treatment are better served in voluntary, non-carceral, clinical treatment settings.”
The report provides a range of recommendations for improving care and reducing harm both inside and outside of correctional facilities, including decriminalization of drug use, ending punitive responses like solitary confinement to drug use inside of jails and prisons, and investing in comprehensive medication-assisted treatment for people who are locked up.
“While corrections officials request further investments under the guise of treatment, the stigma, isolation, and punishment that helped foment the present crisis persist,” the report reads. “Our communities cannot punish their way out of public health crises, but as long as policymakers insist on incarcerating people with substance use disorders, they need to at least provide evidence-based care to those who want and need it.”