By Wesley H. Gallagher
In 1971, President Richard Nixon officially declared war on drugs. This war would be fought with law and order, as the government dramatically increased resources devoted to criminal prohibition of drug use and sales. Between 1980 and 2003, the population of drug offenders in the state prison system grew twelvefold.1
Despite this dramatic increase in the incarceration of drug offenders, drug use rates have not declined, and opioid and heroin use has skyrocketed. Drug overdose is currently the leading cause of death among Americans under 50, yet only one in 10 Americans who struggle with addiction get the treatment they need.2 Clearly, whatever is being done to cure our country’s addiction problem isn’t working.
Jail Time Doesn’t Guarantee Recovery
A common misperception is that drug abuse is simply bad behavior or a series of poor choices driven by a lack of willpower. Extensive scientific research over the past several decades has shown that addiction acts much more like a disease than a bad habit. Prolonged drug use actually causes changes in the structure and function of the brain, causing the addict to need the substance to feel normal and leading to potentially risky behaviors in order to obtain drugs. Often, this risky behavior leads to arrest.
People arrested for drug use are brought into the criminal justice system and treated as criminals — not someone caught in the grip of a terrible disease. They are forced into abstinence, often with no therapy or drugs to assist with detoxing, while being dragged through the stressful, expensive trial process. Once in jail or prison, conditions are no less stressful, and these individuals often lack the support they need to rehabilitate.
In a recent survey performed by the Bureau of Justice Statistics, about half the prisoners in state and federal facilities met criteria for drug abuse or dependence, yet fewer than 20 percent of people who needed treatment received it.3
It is often assumed that the forced abstinence that comes with arrest is equivalent to rehabilitation. In reality, it causes a person’s tolerance to go down and cravings to go up, making the first two weeks after their release one of the most dangerous times in terms of drug overdose.4 Treatment approaches like Motivational Interviewing and cognitive behavioral therapy can inspire change from within and teach addicted individuals the skills needed to avoid relapse upon release. In addition to therapy, many people who use drugs, particularly opioids, need medications that normalize brain function and facilitate abstinence.
Numerous studies have proven the effectiveness of medications like methadone in reducing opiate use, drug-related criminal conduct and HIV risk behavior.3 However, only 23 of 3,200 jails around the country and four of 50 prisons provide methadone or Suboxone maintenance therapy to inmates.4
Despite the widespread underuse of therapy and medicine to treat addicted individuals in prisons and jails, there are jurisdictions working to change the trend. The Rhode Island Department of Corrections’ medication-assisted treatment program provides almost every opiate-addicted inmate access to a range of medications to treat addiction.
Two-dozen county jails in Kentucky have started full-time “therapeutic communities” that provide inmates with treatment similar to private treatment centers, offering GED classes, instruction on criminal-addictive thinking, 12-Step meetings, counseling and a variety of other trainings and treatments. As inmates leave jail, they are given a Vivitrol shot (a medication designed to block the effects of opiates on the brain) and connected to outside resources for recovery maintenance. Studies have shown fewer risk factors for recidivism 12 months after release for participants.2
Risk-free Access to Help Improves Outcomes
Improvements in the way jails and prisons treat those who struggle with addiction are encouraging, but organizations like Human Rights Watch argue that such improvements do nothing to address the larger issue of the number of addicted individuals in the system in the first place. Every year, 1.5 million drug arrests are made — more than all violent crime arrests — and 80 percent of drug arrests are for possession only.5
The declaration of the war on drugs and the subsequent spike in drug arrests has seemingly done nothing to reduce drug use over the last 40 years. In fact, criminalization often brings more harm to individuals, families and communities affected by addiction by punishing an activity that doesn’t directly cause harm to others.
Criminalization of drug use tends to drive people with substance abuse disorders underground, making them less likely to seek the care they need and more likely to engage in unsafe practices that can lead to disease and overdose. Once addicted individuals are arrested, they are often given overly harsh jail sentences or burdensome probation terms that separate them from their families and leave them saddled with debt and unable to find jobs once they are released. And without adequate treatment, those with substance abuse issues are likely to return to drug use and eventually end up back in jail.
Human Rights Watch and the ACLU are fighting for decriminalization of drug possession, coupled with an increase in access to voluntary, affordable and evidence-based drug treatment, social support and other harm reduction measures. Thus far, several jurisdictions have decriminalized possession of small amounts of marijuana, but none have decriminalized possession of other illicit drugs. Examples in other countries and experiments in some US jurisdictions offer hope that decriminalization can work.
Portugal offers a notable example of successful decriminalization in response to problematic drug use. In 2001, Portuguese legislatures eliminated penalties for low-level possession and consumption of all drugs. This was part of a comprehensive plan to address drug abuse through their public health system, expanding treatment and harm reduction services and eliminating barriers to such services. Data shows that drug use has declined since implementation, along with HIV/AIDS and drug overdoses, and many more people are seeking treatment.5
In Gloucester, Massachusetts, a community plagued by heroin use, the Police Department’s Angel program allows addicted individuals to come to the police without risk of arrest and ask for help getting treatment. In the first year of the program, nearly 400 people sought help, and the program has been replicated by more than 150 police departments around the country.6 This is clear evidence that those who struggle with addiction will often seek help if it is offered. But in order for this to work, the risk of arrest had to be removed and the opportunity for treatment made readily available.
Addicted individuals need help, not punishment. Whether through the criminal justice system or through expansion of access to voluntary treatment, addiction must be treated as the disease that it is, and people need access to the resources necessary to get and stay clean.
1 Stauffer, Brian. “Every 25 Seconds: The Human Toll of Criminalizing Drug Use in the United States.” Human Rights Watch, October 12, 2016.
2 Quinones, Sam. “Addicts Need Help. Jails Could Have the Answer.” The New York Times, June 16, 2017.
3 “Principles of Drug Abuse Treatment for Criminal Justice Populations – A Research-Based Guide.” National Institute on Drug Abuse, April 18, 2014.
4 Schwartzapfel, Beth. “A Better Way to Treat Addiction in Jail.” The Marshall Project, March 1, 2017.
5 “It’s Time for the U.S. to Decriminalize Drug Use and Possession.” The Drug Policy Alliance, July 2017.
6 Marcelo, Philip. “Researchers: Gloucester’s Angel Program Helped Nearly 400 Addicts.” CBS Boston, December 21, 2016.