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National Assembly: Drugs, Alcohol Abuse,
and the Criminal Offender
Wednesday, December 8, 1999

Luncheon Presentation

Treatment and Training for Substance Abusing Prisoners: Can Good Public Policy Be Good Politics?

Susan Foster, Vice President and Director,
Policy Research and Analysis
National Center on Addiction and Substance Abuse at Columbia University
New York, New York

Summary of Proceedings

Public policymakers, state and federal health officials, and penal authorities need to recognize that substance abuse and the commission of serious crimes are linked inextricably and that mandatory treatment of substance abuse is necessary for the overwhelming majority of criminals. Trying to fight crime almost entirely through imprisonment has been like "trying to fight a cold by buying lots of Kleenex," Susan Foster argued.

Instead of preventing crime in the first place, we have been making sure that we have plenty of space to keep criminals after they have committed a crime. Excessive reliance on imprisonment and the failure to take advantage of inmates' incarceration to insist on treatment reflect an inefficient use of limited resources and a failure to protect society in the long run.

The overwhelming majority of the 1.9 million offenders in the United States have substance abuse and related mental health problems and are "amenable to treatment," said Foster. Most of these inmates go untreated and often their situations worsen. These prisoners are eventually released into society, and most become reinvolved with substance abuse and the serious crimes that spring from this abuse. They return to prison to take up one of the costly cells that Americans have been building at a brisk pace in the last decade. In 1996 alone, for example, prison construction funding increased by 28 percent, Foster noted. Today, offenders are incarcerated in the United States at a rate 10 times greater than in Europe and 20 times greater than in Japan.

Foster presented three major reasons for why the United States has not taken more decisive action to understand and deal with the link between substance abuse and criminal activity:

  • Some believe that treatment for drug abuse is antithetical to a "tough on crime" policy. Treatment advocates are seen as "coddlers of the ... offender as victim," who would "hug [these offenders] to their collective breast, and provide soft and comforting treatment." This argument is "silly," said Foster. "Addiction is a disease with particularly nasty consequences." A diabetic's indulgence in the wrong foods or lack of exercise can result in a deterioration of his or her condition, but is unlikely to result in activities that lead to prison. On the other hand, drug or alcohol abuse could very well result in activities that harm others.
  • "Tough on crime" proponents say that there is no need or obligation to treat criminals, only to get them off the street. The flaw with this reasoning is that prisons routinely release substance-abusing offenders, including those who have committed violent crimes, and that untreated inmates are likely to return to a life of crime. The failure to treat substance-abusing criminals is "tantamount to visiting criminals on society," Foster said. "Only by treating the disease do we have any hope of stemming the tide of [negative] social consequences."
  • The discussion about what to do with the vast majority of criminals who have substance abuse problems is wrongly framed as an either/or question. The truly "tough" approach is to demand both substance abuse treatment and accountability for criminal behavior. In addition, if being tough on crime means mandatory sentencing without parole—and without treatment—we are being ineffective in another sense; we are losing both the "carrot" that can get criminals into treatment and the "stick" that threatens reincarceration if a released prisoner fails to stay off drugs. Many political leaders and policymakers ask: "How can I vote to spend money to help criminals when my constituents want more money for schools, hospitals, roads and bridges?"

In response, Foster argued that if we can adequately treat and return prisoners to the community, we will free up money to pay for these other needed items. If we do not deal appropriately with the link between substance abuse and criminal activity, we will need to dedicate ever larger portions of state and local budgets to building and operating prisons.

Foster estimated that spending an additional $6,500 per prisoner, per year to provide treatment for substance abuse would result in an annual return of nearly 10 times this investment, or approximately $68,000 per prisoner. For every year these former inmates remain drug free, the United States economy would see a total benefit of $8.9 billion. These savings would come from avoided incarceration and health care costs and from taxes paid by released, rehabilitated prisoners.

"We have a choice," Foster concluded. "We can spend more time coming to meetings, beating our breasts about how we lack resources, cooperation, and leadership—which we do—or we can rise up as policymakers and political leaders to the call of common sense . . . treat the disease, account for the crime."


Last Updated: March 4, 2002

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