Nearly half of all federal inmates are incarcerated for drug offenses, according to the Federal Bureau of Prisons. Among this population, one offense often leads to another. Data shows that 77% of individuals convicted of a drug offense are convicted again within nine years.
While in prison, individuals with a substance use disorder (SUD) struggle to receive treatment. While 65% of inmates have SUD, only a small portion of government spending supports prevention or treatment for inmates. Most facilities offer little or no SUD support, even though research from the Office of National Drug Control Policy reveals great cost savings. For every dollar spent on treating SUD, $4 is saved in healthcare costs, and $7 is saved in law enforcement and criminal justice expenses.
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The Legal System: How SUD Intersects with Incarceration
Police officers and other first responders routinely encounter individuals with SUD, yet they are often not trained or supported in how to assist this population. Municipalities nationwide are piloting new approaches, such as crisis intervention teams and co-response models, to train officers on how to respond to individuals in crisis and to provide professional mental health practitioners who accompany officers on calls. New roles like behavioral health officers are being added to departments and agencies. In addition to better understanding optimal approaches for people with SUD, these officers work closely with local diversion programs and resources to keep them out of jail and connect them to help.
Drug courts are also effective in helping individuals with SUD work toward recovery rather than incarceration. Drug courts offer people the opportunity to seek treatment and agree to court supervision rather than receiving a jail sentence. Individuals agree to maintain recovery and work toward lifestyle changes in these programs. The court monitors their progress. Successful drug courts reduce recidivism by 35 to 40%, according to a National Institute of Justice study.
Understanding the Financial Impact.
Considering the economic implications of incarceration versus rehabilitation reveals a stark contrast:
Investing in rehabilitation not only fosters healthier communities but also significantly reduces public expenditure.
Diversion programs and drug courts, however, are not available everywhere. Involvement in the criminal justice system starts after an individual is arrested, and it includes pretrial detention, conviction, incarceration, probation, and parole. Entry into the system often has lasting consequences, affecting physical and mental health, employment opportunities, family relationships, access to housing, education, and financial security. For individuals with SUD, the stakes are even higher.
There is a significant risk of serious injury or even death from drug withdrawal within the first few hours and days of detainment if an individual doesn’t receive timely medical attention. Between 2000 and 2019, the number of local jail inmates who died from all causes increased by 33%, while the number who died from drug or alcohol intoxication during the same span increased by nearly 400%. Unmanaged withdrawal symptoms can lead to severe health complications and even death. Additionally, SUD and alcohol use disorder (AUD) are significant contributors to suicide rates in jails.
In addition to perpetuating poor outcomes for individuals and straining the criminal justice system, incarcerating individuals with SUD is a financial burden on communities and states. The average cost of incarceration varies widely by state, ranging from $20,000 to upwards of $300,000 per inmate per year. Drug rehabilitation costs significantly less, typically around $5,000 to $20,000 per person annually. In addition, when cases are handled in drug courts rather than conventional courts, it saves the public an average of $6,744 per participant.
Further, individuals assigned to drug court are 66% less likely to be re-arrested compared with those who are incarcerated, which reduces the burden on the criminal justice system.
Addressing this gap in care presents an opportunity to reduce recidivism, prevent drug overdose deaths, and improve outcomes for inmates and their communities.
Barriers to SUD Treatment in Prisons and Jails
Despite the clear risks of untreated SUD, less than 20% of inmates receive treatment. Substance use often continues while incarcerated and after release, often with devastating consequences. Within the first two weeks after release from incarceration, former inmates are 40 times more likely to die from an opioid overdose than the general public.
The Eighth Amendment to the Constitution protects inmates from “cruel and unusual punishment,” which includes the right to healthcare. A 1976 U.S. Supreme Court case established that the amendment covers prisoners’ healthcare, meaning incarcerated people are the only group in the U.S. with a constitutional right to care. Yet systemic issues—such as overcrowding, underfunding, and stigma surrounding SUD—prevent many inmates from receiving necessary care.
Only around 12% of prisons and jails in the U.S. offer medication-assisted treatment (MAT), even though it is recognized as one of the most effective methods to help people with SUD. The most common reasons MAT isn’t offered are a lack of qualified or licensed staff to administer it, a bias against it by officials who think of it as “giving drugs to addicts,” cost, insurance, and other regulations.
Addressing these systemic barriers is essential to improving the outcomes for individuals with SUD in the criminal justice system.
Solutions for Addressing SUD in the Criminal Justice System
Many areas need to be addressed to make meaningful changes in the criminal justice system.
- Expand access to evidence-based treatments: Little improvement will occur without better access to treatment. As an example, several medications are approved for individuals with opioid-use disorder, but these medication-assisted treatments are rarely available to people who are incarcerated. A recent National Academy of Sciences report revealed only 5% of inmates with opioid-use disorder receive medication treatment. In addition, behavioral therapies such as Cognitive Behavioral Therapy, which helps modify drug-use expectations and behaviors, and Contingency Management Therapy, which provides motivational incentives for positive behaviors, are highly effective, but a comprehensive approach to treatment for individuals who are incarcerated is required to put them in place.
- Leverage peer support systems: Correctional staff, clinicians, and social workers play a critical role in supporting inmates, but peer support can be powerful and transformative. Peers help reduce stigma, provide guidance, and improve recovery outcomes. Peer support can begin while an individual is incarcerated and extend to the period after release to help individuals as they re-enter society.
- Adopt trauma-informed correctional care: Health care and support that takes into account the high rates of post-traumatic stress disorder and exposure to violence among individuals who are incarcerated is critically important when you consider that many are also experiencing “forced withdrawal” from substances. The use of appropriate therapies and education around coping skills can help stabilize inmates with SUD, going a long way toward creating an environment that is conducive to rehabilitation and reduces the likelihood of reoffending.
- Prioritize re-entry planning and support: A 2023 report from the Substance Abuse and Mental Health Services Administration outlines best practices for successful re-entry from incarceration for individuals with SUD and/or mental health issues. The report notes that inmates often resume using substances upon release, which can lead them back into the criminal justice system. There are multiple models to support individuals as they are released from prison and reintegrate, including overdose prevention efforts and harm reduction measures, which are aimed at reducing the negative consequences of drug use. These are among several options outlined in the report that can reduce the risk of overdose, death by suicide, or re-incarceration. More attention is needed on the challenges individuals face after incarceration: difficulty finding housing, getting hired, and financial problems.
Digital Tools Bolster Recovery Program for Women.
About five years ago, officials with the Women In Recovery (WIR) diversion program in Tulsa, Oklahoma, implemented a new approach to help women facing long prison sentences for non-violent, drug-related offenses. After a pilot with CHESS Health’s evidence-based eRecovery solution yielded positive results, officials made the digital recovery support tool available to participants in its intensive program that provides housing for women while they go through treatment.
Participants in the WIR program embraced the app, and program officials were impressed with the results. In a short period of time, they noted participants using the Connections app remained in treatment an average of 37 days longer with a 24% lower rate of return to use and a 19% higher rate of program completion. Women who complete the program continue to have access to the app to stay connected to recovery support, offering them a digital lifeline as they move back into their communities.
A Coordinated Effort for Systemic Reform
Breaking the cycle of substance use disorder (SUD) and incarceration requires a unified approach. We must eliminate barriers to care and emphasize re-entry and ongoing recovery support.
Key strategies include integrating medication-assisted treatment, harm reduction, peer support, and trauma-informed care into prison systems across the nation. Re-entry planning should begin on day one of incarceration, offering robust support for life after release.
By adopting these evidence-based approaches, the criminal justice system can reduce recidivism, save lives, and create an environment conducive to rehabilitation and recovery.
