Time Well Served - by: Daniel V. Lane, JD, CCRC II, MAFC

The path of destruction that addiction foists upon its victims, ultimately leads these men and women through the doors of the criminal justice system. In the past, consequences in the form of punishment were viewed as the only solution. As we have reviewed during the first four segments of this ongoing series, many enlightened souls in the legal community have begun to see that punishment is not the answer and alternatives to incarceration through diversion, alternative sentencing and drug courts offer a better way.

However, many alcoholics and addicts are still not afforded these opportunities to undergo treatment. Some continue to fall prey to the ignorance of the past. Hopefully, this series of articles has become an additional voice that will facilitate change in this regard. However, there are others, those most frequently denied treatment, alcoholics and addicts whose addiction has resulted in repetitive criminal activity, violent behavior, or the serious injury to or death of innocent citizens.

The hypocrisy of a result that denies treatment to victims of addiction solely on the basis of the nature of the resulting negative behavior is best illustrated by a comparison of two drunk drivers, both of whom suffer from the genetic diseases of addiction. The first, we’ll call him Mr. Lucky, has a prior history of three public intoxication convictions and one prior conviction of driving under the influence. Neither of the incidents of driving under the influence has resulted in an accident or injuries to innocent citizens. In the present scheme of things, this individual will clearly qualify for treatment as an alternative to incarceration. As a result, he and society has an increased chance that this negative behavior will not be repeated.

Consider, however, our second drunk driver who we’ll call Mr. Unlucky. He is a first-time offender with no prior arrest history whose behavior results in a major automobile accident in which an innocent citizen loses her life. Will this alcoholic receive an alternative sentence of treatment? Most likely, the answer is no. He will not pass go and proceed directly to jail, where he will receive no or ineffective treatment, and, at the conclusion of his period of incarceration, will be returned to society to again put him and others at risk. For a society that prides itself in its enlightenment, this is a sad commentary.

In Turning the Tide, I alluded to one possible solution to this dichotomy, that being that there have been positive results achieved through treatment as an alternative to incarceration of some repeat or violent offenders as well as some whose addiction has resulted in serious injury or death. However, in advocating this solution, I am not oblivious to forces within and without the legal community that render unlikely current prospects for a substantial increase in alternative sentencing opportunities for these offenders. The ongoing ignorance of some and continuing blind advocacy of punishment by interest groups such as MADD creates political realities for those who work in the criminal justice system. The job security for judges and prosecutors rests in the hands of an electorate whose opinions are molded by the media and public interest groups whose true interest is more personal than public. As a result, until the prevailing veil of ignorance is permanently lifted, this best solution will unfortunately not be fully utilized. More pain and suffering for individuals and society as a whole will be the result.

There is, however, another possibility, albeit not preferred, which despite clear difficulties in implementation and delivery now deserves our attention, treatment in jails or prisons. This is a subject that will require us to take more than one look. We must first examine the history of treatment in a correctional setting and present needs and results before proceeding to consider the difficulties inherent in providing treatment and the feasibility of providing a viable treatment experience for inmates. So, let us begin.

Prison-based treatment is not a new idea. The first such program was initiated in 1935 by the U.S. Public Health Service Hospital in Lexington, Kentucky, which provided substance abuse treatment for federal inmates housed at a nearby penitentiary. Three years later, a similar program was established in a hospital adjacent to a federal penal institution in Fort Worth, Texas. Both of these programs appeared out of Congressional concern about overcrowding in federal prisons caused by the incarceration of drug addicts during the 1920’s.¹ The programs continued until the 1960’s, despite high relapse rates. In the early 1970’s, both were closed and converted to prisons, as the Federal Bureau of Prisons began to develop treatment programs inside the correctional institutions.²

In the midst of these changes, in 1966 Congress enacted the Narcotic Addict Rehabilitation Act (NARA) which authorized sentencing federal offenders to treatment in lieu of prison if the Attorney General determined the offender was a drug addict and likely to be rehabilitated.³ A special civil commitment system was established to assess and monitor federal inmates both before and after sentencing. Under this program, inmates were required to spend a minimum of six months in treatment before conditional release to community-based treatment.

In 1976, in the case of Estelle v. Gamble, the U.S. Supreme Court found that deliberate indifference to serious medical needs of a prisoner is cruel and unusual punishment in violation of the Eighth Amendment to the U.S. Constitution.⁴ This decision, although not dealing directly with substance abuse treatment, opened the door to further efforts to expand treatment options inside the Federal Bureau of Prisons.

In the 1980’s, as we have reflected earlier in this series, political forces initiated the War on Drugs. A colleague of mine recently shared something he heard at a seminar, the war was not one on drugs, but one on alcoholics and drug addicts. As a result, not only do drugs continue to be a problem, but also there has followed a massive proliferation of the inmate population in this country to the point that the vast majority of those now incarcerated in our state and federal prisons are alcoholics and addicts. The actual numbers are staggering – from 1990-1996, 75% of state inmates and 31% of federal inmates were in need of substance abuse treatment. And despite all the funds allocated for the War, little was left to deal with the problem in the prison system. While the number of inmates needing treatment between 1993 and 1996 increased by 22% from 688,415 to 840,188, in 1993 22% of those needing treatment were receiving it while in 1996 only 18% of needy inmates were in treatment.⁵

Why so much inefficiency and inability to serve the needs? In response to surveys, more than 70% of correctional departments blamed budgetary limits, such as salaries for clinically trained addiction counselors, funds for equipment and supplies. More than one-third reported that they have too few counselors. More than half; do not have enough space in treatment programs, causing long waiting lists and an inability to keep pace with the increasing numbers of inmates who need help. More than ten percent identified frequent inmate transfers to other facilities or sentences that were too short to allow them to complete a treatment program. Lack of inmate interest in participating was also cited.⁶

Clearly something is remiss in our priorities. Having now reviewed the history of treatment in a correctional setting, the present needs, and the failure to meet these needs, the stage is set for the sixth segment of Recovery & The Law. Next month we will examine difficulties inherent in providing treatment inside, and the feasibility of offering a viable treatment experience for inmates. In the process, we will learn that this is no easy task. Yet, it is an effort worth the struggle. If we do not adequately address this issue, one day nearly one million untreated alcoholics and addicts will reenter society. They may have completed their sentences, been duly punished by our legal system, but our investment and theirs will not have resulted in time well served. We, individually and collectively, will have done nothing to facilitate permanent positive change in their lives or ours. Join me again next month as we seek the solutions that can and will make that change a reality.

1. Nurco, D.N., Hanlon, T.E., Bateman, R.W., & Kinlock, T.W. (1995). Drug Abuse Treatment in the Context of Correctional Surveillance. Journal of Substance Abuse Treatment, 12 (1), 19-27.

2. Keve, P.W. (1991). Prisons and the American Conscience: A History of U.S. Federal Corrections. Carbondale, IL: Southern Illinois University Press.

3. Rouse, J.J. (1991). Evaluation Research on Prison-Based Drug Treatment Programs and Some Policy Implications. International Journal of Addictions, 26 (1), 29-44.

4. Estelle v. Gamble, 429 U.S. 97 (1976).

5. Camp, G.M., Camp, C.G., & Criminal Justice Institute. (1996). The Corrections Yearbook: 1996. South Salem: Criminal Justice Institute.

6. CASA. (1998). Behind Bars: Substance Abuse and America’s Prison Population. Charles E. Culpeper Foundation; The Robert Wood Johnson Foundation. p. 118.

Daniel V. Lane is a former attorney with an undergraduate degree from the University of Southern California and a degree of Juris Doctor from Southwestern University School of Law. His experience in the field of chemical dependency includes both correctional and community-based treatment settings. He is SASCA Case Manager for Cornerstone of Southern California and has certifications as a supervisory level Criminal Reformation Clinician and a Master Addictions Forensic Counselor. He is the author of numerous articles in regional and national professional publications in addition to his ongoing series, "Recovery & The Law," currently appearing at www.anonymousone.com. In addition to writing in the field of chemical dependency, he frequently lectures on a variety of recovery topics, including spirituality & the 12-Steps, the diseases of addiction and the use of rational emotive therapeutic techniques in recovery. You can contact by e-mail bluephoenix@Adelphia.net