Treatment can help curb the cycle of crime, substance abuse among inmates. In America, crime and substance abuse are tightly enmeshed.

Research by the National Center on Addiction and Substance Abuse at Columbia University (CASA) and the U.S. Department of Justice shows that 80 percent of the 2 million men and women behind bars today -- some 1.6 million individuals -- are "seriously involved with drug and alcohol abuse." Not surprisingly, 80 percent of all inmates are incarcerated for drug-related offenses (i.e., either the offender was using alcohol or other drugs at the time of the offense, was committing the crime to buy drugs, or the crime directly involved the sale or distribution of illegal drugs).

Despite the well-documented link between substance abuse and crime, few inmates receive any help at all for their addictive and criminal behaviors. "There is a profound lack of treatment opportunities for inmates, and that problem has worsened significantly in the last decade," said Susan Turner, PhD, associate director of the Criminal Justice System at RAND in Santa Monica, Calif.

According to the Department of Justice, at most, 20 percent of inmates with a substance abuse problem have received treatment, and only 40 percent of correctional facilities offer substance abuse treatment. "If you understand how people behave, it simply makes no sense to just push inmates out the door without the resources to function in society," said Turner. "From a cost-benefit view, if not a compassionate standpoint, treatment makes sense. It's just very expensive to incarcerate people."

How expensive? Costs vary among states, but on average, they fall between $20,000 and $25,000 per inmate per year-for an annual total of $40 billion. The CASA report estimates that providing alcohol/drug treatment and vocational and treatment aftercare would add approximately $6,500 per inmate to that amount. The savings gained for society as a result of successful treatment, however, far exceeds these costs. If only 10 percent of inmates with substance abuse problems were successfully treated, the economic benefit (in reduced crime; reduced arrest, prosecution, and incarceration costs; reduced health care costs; and more) in the first year after release alone would be slightly more than $8 billion. That total is more than the $7.8 billion it would cost to provide treatment to the entire 80 percent of inmates with alcohol/drug problems. And for each year that treated inmates remain sober and employed, the economic benefits soar into the tens of billions of dollars-a return on investment to capture the imagination of any businessperson.

But can treatment for criminal and addictive behavior work with this difficult population? After analyzing over 700 research papers on this topic, Paul Gendreau and Claire Goggin, researchers at the Centre for Criminal Justice Studies at the University of New Brunswick in Canada, found that "effective treatment programs" -- those which are behavioral/highly structured in nature and target the criminal attitudes, values, and behaviors of high risk offenders-lowered re-offense rates by 30 percent. These programs did not necessarily address drug/alcohol problems; had they done so, Gendreau and Goggin believe treatment results would have been even more impressive.

"From a clinical and policy perspective, the usefulness of [effective programs] is far from trivial," Gendreau and Goggin conclude. "The old myth propagated by 'nothing works' devotees -- that offenders are of such a peculiar psychobiological nature that they are beyond responding positively to interventions designed to reduce criminal behavior -- has finally been put to rest."

The approach Gendreau and Goggin found most successful -- known as cognitive-behavioral-focuses on clients' thoughts and beliefs and how they affect behavior and on the clients' practice of new behaviors. That focus is right in line with the efforts of Hazelden and the Minnesota Department of Corrections, who have collaborated to develop a new program that treats both addiction and criminal behavior with cognitive-behavioral techniques. This comprehensive program will help inmates build the skills and support needed to live a sober, productive life outside prison.

If a key goal of our criminal justice system is to reduce crime and rehabilitate inmates to become productive citizens, then for many substance-abusing and addicted inmates a prison sentence alone is simply not enough. "The need for more effective treatment is unequivocal," says Jeff Washington, deputy executive director of the American Correctional Association. "Providing prison populations with access to effective treatment programs that address the disorders of criminal thinking and substance abuse concurrently makes great sense and offers an excellent opportunity to give more inmates the help they need."

Alive & Free is a chemical health column provided by Hazelden, a nonprofit agency based in Center City, Minn., that offers a wide range of information and services relating to addiction and recovery. For more resources on substance abuse, call Hazelden at 1-800-257-7810 or check its Web site at www.hazelden.org.

Originally Published February 11, 2002