SPECIAL POPULATION & SUBSTANCE ABUSE Special Population and Substance Abuse

Prison inmates and substance abuse

Drug courses or rehabilitation programs for drug offenders

The reoffender issue

Drawbacks of not providing rehab treatments and facilities

Cost vs. benefit analysis if rehabilitation programs and imprisonment

Drug abuse or substance abuse is a major issue in the U.S. It is the addictive and patterned use of drugs in quantities that are not approved by the health and medication regulating bodies, neither administered under the supervision of any clinician. Substance abuse covers wide categories of drugs used without the prescription of health administrators with excessive and often dangerous consumption levels. Substance abuse includes the use of performance enhancing and psychoactive drugs. The leading organizations that issue the standards and symptoms of drug and substance abuse are World Health Organization's International Statistical Classification of Diseases, American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and ICRIS Medical organization Related Health Problems (ICD). Substance abuse is a blanket term used to describe excessive and illegal use of any drug not being allowed to the user. World Health Organization (WHO) defines substance abuse as "Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use" (WHO).

The research paper is aimed to present an informed discussion on substance abuse in context of prison inmates. There are large percentages of prisoners in each U.S. state that fall within the category of substance abuse according to the DSM IV medical criteria. Section two of the paper will discuss substance abuse in context of prisoners and the current findings of leading health organizations in this regard. Section III will highlight the significance of drug courses or rehabilitation programs for drug offender inmates. Section IV will include discussion on the reoffender issue followed by analysis of rehabilitation programs in section V along with drawbacks of non-provisionof rehab treatments and facilities to inmates. Sections VI and VII shall describe the cost vs. benefit analysis of rehabilitation programs and imprisonment in the U.S. And conclusion of the paper respectively.

II- Prison inmates and substance abuse

The National Center on Addiction and Substance Abuse, Columbia University in 2010 reported that out of the total of 2.3 million inmates in the U.S. prisons, 1.5 million meet the criteria of substance abuse and addiction defined by Diagnostic and Statistical Manual of Mental Disorders (DSM) IV. The report also mentioned the presence of another 458,000 inmates having significant history of substance abuse, under influence of drugs during the crime, or incarcerated for drug abuse crimes. Thus, having combined the total population of the U.S. inmates falling within the category of substance abusers was assessed to be 85% of the total U.S. inmates in prisons (CASAColumbia, 2010). This indicates towards the graveness of substance abuse issue in the U.S. prisons and also highlights the importance of arranging for rehabilitation interventions for these inmates. A rather old study conducted on the issue of substance abuse in the U.S. prisons was that by Peters, et al. (1998) in which the authors concluded that as much as 74% of the 400 inmates being clinically assessed for substance abuse DSM-IV alcohol and drug disorders resulted positive. 46% of the total inmates that were investigated for the disorder were dependent on alcohol or drugs.

Although, conducted on a small scale, the results of the study are significant in understanding the overall trend of a sharp increase of DSM-IV substance abuse disorder in the U.S. inmates during the last one decade. The findings of Peters, et al. (1998) and those reported by Colombia University indicate the same. Fazel, Bains and Doll (2006) also conducted a study in which systematic review was performed of studies already carried out on prevalence of drug and substance abuse in the U.S. inmates. The results were somewhat different as less disturbing as compared to the findings of Colombia University and Peters, et al. (1998).13 studies were being reviewed in which 7563 prisoners met review criteria.

For male inmates, substance and alcohol abuse was reported to have ranged between 18 to 30% whereas for female inmates it was 10 to 24%. The authors suggested that screening tests should be conducted at the time of prison admission whereas to curb the substance abuse addiction, treatment during custody should be offered along with follow-up on releasing the inmates. The three studies being reviewed suggested improvement in treatment capacity of prisons to reduce the staggering percentage of...

prisons.
III- Drug courses or rehabilitation programs for drug offenders

The rate of incarceration in the U.S. Federal and State institutions has increased manifold since early 1980s till late 2000s (See Appendix I). There has been considerable lax performance of the U.S. government in addressing the issue of treating the substance abusers in the U.S. prisons. Since the disorder treatment is multifaceted (Field, 1998), the service providers for rehabilitating the offenders are least prepared to customize the treatment programs in order to match individual requirement of drug offenders. The difference in culture, gender, age, and type of criminal offense of substance abuser necessitates that State governments and service providers arrange to provide customized treatment plans to better results of treatment. The Drug Courts Program Office is such a sustained effort on part of the government that has helped reduce the number substance abusers getting involved in crimes or abuse of drugs while being prisons. The program was only initiated as community-based treatment and supervision plan program for felony drug offenders. 48 out of 50 U.S. States now have operationalized Drug Courts. The effectiveness of Drug Courts has been significant in terms of saving tax payer money as the courts ensure that duplication of service does not occur in treatment programs, accountability of public service provision to drug abusers, greater accountability of drug abuse defendants, and speedy disposal of cases. Had the drug courts not been present, more of tax payers' money with little accountability would have been spent on treatment programs for substance abusing inmates. The effectiveness of drug courts is also evident from the facts such as that retention rates in drug courts treatment programs has been double as compared to other treatment programs. Till 1998, 100,000 had entered in treatment programs offered by drug courts.

Other forms of rehabilitation that have achieved success in treating inmate substance abusers include the programs offered by Bureau of Prisons, U.S. The programs offered by BOP run across all the geographic regions such as Northeast region, Mid-Atlantic region, North-Central, Western, Southeast and South-Central regions. Programs being offered include:

Residential Drug Abuse Program (RDAP): A nine months substance abuse treatment program comprising of programming of half-day along with half-day work, vocational and school activities. The research findings suggest that RDAP users are less likely to relapse or recidivate.

Community Transition Drug Abuse Treatment (TDAT): This is also a community-based treatment program offered when an inmate gets transferred to residential reentry center (RRC). Chances to relapse to drug abuse and criminal activity are highest during this period. Clinical supervision in provided to inmates with drug disorder symptoms, mental illness, and psycho-behavioral issues (FederalBureau of Prisons, 2011). The State of California has effectuated many treatment programs including In-Prison Substance Abuse Programs (SAPs), Female Offender Treatment and Employment Program (FOTEP), Parolee Services Network (PSN), The In-Custody Drug Treatment Program (ICDTP), and Senate Bill 1453 (CDCR, 2013). All these programs are aimed at effective, speedy, cost effective, and comprehensive treatment of substance abusing offenders.

IV- The reoffender issue

The issue of re-offending in inmates relapsing to drug and substance abuse is also significant in order to deal the issue in totality. The issue of re-offending is significant as many governments of the world are striving to address the challenge of decreasing re-offend rates. The government of New Zealand also published a report in 2010. The study by NSW Justice Health indicated that inmates having substance abuse disorders along with non-substance disorder were likely to re-offend due to the complexity of their issue, mental and physical. "After adjustment for demographic and criminal history characteristics, the rate of re-offending among prisoners who had co-morbid substance and non-substance mental health disorders was 67 per cent, compared with 55 per cent among prisoners who had only a substance disorder" (Smith & Trimboli, 2010; Pg. 1). The findings suggest that the value of investments in treatment and rehabilitation programs of inmate substance abusers is high and to prevent high rate of re-offending, the federal and state government need to coordinate and collaborate in treatment and prevention programs. Since there are many costs involved after the inmates re-offend, much emphasis has been laid on improving the treatment services and availability of services to inmates in the U.S. prisons. Remaining uneducated and unskilled is also amongst main reasons of re-offending in the U.S. inmates. Lack of solid family support is also detrimental to the cause of rehabilitation of inmates (Petersilia, 2000). Most of the paroles fail and rearrests…