In 2008, military veteran Derek Harris was arrested in Louisiana for selling .69 grams of marijuana—a value of around $30. Mr. Harris was sentenced to fifteen years in prison and later resentenced to life due to previous offenses related to his drug dependency, which began while serving in Operation Desert Storm. On August 19, 2020, Mr. Harris was released after nearly ten years in prison (Maxouris, 2020).
In 2010, Patricia Spottedcrow was arrested for selling $31 worth of marijuana after financial problems caused her to lose her home. She was sentenced to twelve years in prison. It was her first charge, and she was released after two years (Malone, 2019).
These are just two of the many of Americans who received sentences up to life for selling cannabis. In a time where many states have legalized marijuana, these cases present a stark reality for many still in prison with similar sentences.
For years we have discussed the issue of criminal justice reform, but we are still woefully lacking in significant changes to the system. The United States leads the world in incarceration, with “nearly 7 million persons under criminal justice supervision” (Porter, 2020). More than 10.3 million arrests were made in the United States in 2018 (FBI, 2019), and of that the highest arrest rates were for drug offenses followed by larceny and driving under the influence. According to the Partnership to End Addiction, by 2006, 2.3 million Americans were incarcerated and “. . . prisons and jails held an estimated 1 million substance-involved parents with more than 2.2 million minor children” (Partnership to End Addiction, 2010a). About one out of one hundred individuals in our country (i.e., 0.7 percent) are, as of last year, in a federal or state prison or jail (Wagner & Bertram, 2020).
The cost of incarceration is staggering. In 2005, “federal, state, and local governments spent $74 billion on incarceration, court proceedings, probation, and parole for substance-involved adult and juvenile offenders,” according to the Partnership to End Addiction (2010b). In the two examples provided previously, our country spent $330,000 to incarcerate Mr. Harris for $30 worth of cannabis and roughly $66,000 to incarcerate Ms. Spottedcrow (Maxouris, 2020; Malone 2019). That cost does not even consider the cost of judicial processes leading to the conviction. In no way does this make any sense from a financial, criminal justice, or treatment perspective. Additionally, the United States spends $80.7 billion per year in incarceration cost—prisons, jails, parole, and probation (Wagner & Rabuy, 2017). Yes, that is “B” as in “billion.”
Not only is cost a significant issue and reason for reform, but of the 2.3 million individuals in jails and prisons, 85 percent were substance involved and another 1.5 million met criteria for addiction (Partnership to End Addiction, 2010a). Additionally, 458,000 incarcerated individuals reported prior use of substances or were under the influence of substances while committing their offense, while more than half of those incarcerated reported problems with alcohol (Partnership to End Addiction, 2010a, 2010b). Despite all these significant numbers, only 11 percent of the aforementioned individuals received treatment (Partnership to End Addiction, 2010a). If all inmates in need of treatment received such services, the nation would see significant economic benefits in just one year.
For many years I have had the opportunity to work in different countries and see how they manage criminal justice and treatment issues. I have worked in South Africa for nearly twelve years with youth justice programs, and those particular facilities had some of the best comprehensive treatment programs I have seen. Not only was the treatment well done, but each youth received a certificate in some vocation such as carpentry, catering, restaurant management, brick laying, HVAC, and many others. The youth had certifications and training in their chosen vocation, and they all had jobs upon release. Many of the youth who served time in those facilities came back and worked in jobs at the facility. These are solutions that make a difference in system changes and improving lives.
The surge of opiate use has also caused the United States significant issues. Individuals who were arrested and using opiates often developed high tolerances. Without having treatment or education during their incarceration, many of those individuals were later released and went back to using at the amount they were using before incarceration (NIDA, 2020). Unfortunately, due to the changes in tolerance, many overdosed when they returned to their normal use after release. Education and treatment certainly can save lives.
The substance use treatment system needs reform to reflect current needs. Our treatment system was originally developed with a completely abstinence-based, Twelve-Step-only approach to treatment. The United States still has not fully embraced the use of harm reduction and use of medications to treat SUDs, and the use of medications in the justice system has been met with significant resistance over the years. It is not unusual for treatment in the present day to have people stop using more harmful substances and move to cannabis. Providers may need to pick their battles and use that movement as another step toward a recovery process and not as a reason to discharge individuals from a program. For some reason the treatment field has wanted to discharge very ill individuals from treatment for acting on the symptoms of their illness, as that may not look like what has been defined as “recovery” in the past. There are many different paths to recovery and treatment options should reflect those changes.
Providers should use an integrated approach to treatment. They should fully address not only the treatment needs and the behaviors that caused individuals to be involved in the justice system in the first place, but the significant issues that continue well after release. Providers should address changing attitudes and values associated with behaviors and addressing criminality. Conviction impacts individuals for life—many experience significant barriers in regards to employment, housing, and other such areas. If left unaddressed, those individuals often become frustrated with justice system requirements to get a job and find housing when their criminal histories block attempts at those goals.
Treatment systems needs to be aware of language. Instead of stating that someone is “suffering from” or “battling addiction,” perhaps say that person is “living in recovery.” It is essential to get individuals (and providers) away from referring to themselves as their illnesses, old terminologies and philosophies such as “denial” and “hitting rock bottom,” and moving toward strength-based approaches and positive language.
Individuals who have SUDs and are involved in the justice system are some of the most complex and high-risk individuals to treat. However, this population is often treated by staff who are untrained in SUDs. Many licensed staff may not have had any coursework or experience with this population, but because of their license they are allowed to provide services. In many states, certified addiction counselors are only allowed limited duties despite being specifically trained to treat SUDs. Because this population can be very challenging to treat, professionals need to be dually trained to manage both the SUD and the behaviors that led their patients into the justice system. It is imperative to address manipulation and clearly define boundaries. Treatment providers need to expand how they see treatment. As stated previously, there are many ways to help individuals find their own paths to recovery, and what works for some individuals may not be the solution for others.
Criminal justice programs need to use medications, when needed, to treat this population. Failure to use medications to treat SUDs can cost a life. Due to the lack of prescribers, physicians who have never had any experience in treating SUDs—or had any coursework about SUDs in medical school—are allowed to prescribe medications. Physicians need to have the proper and relevant education to prescribe these medications. Medical schools need to step up and provide education on SUDs. Lives depend on it.
Additionally, the right medications need to be used for the right situations. While training last year, a federal probation officer stated she had a probationer who had only been confirmed as using cannabis and was prescribed naltrexone (i.e., Vivitrol). She asked me if that sounded appropriate. It is a huge understatement to that say my response did not support that kind of intervention. There have been some clinical trials using naltrexone for cannabis use, but those trials have found different results and much more study is necessary (Brezing & Levin, 2018). The use of this medication for cannabis use is currently not FDA approved.
Criminal justice programs should provide and expand treatment in their facilities and provide comprehensive discharge and aftercare planning. Programs should use evidence-based treatments that have demonstrated successful outcomes with this population. Jail and prison treatment programs should require a review of programming or accreditation, and justice-related trauma should be brought out of the dark, openly addressed, and appropriately treated.
Further, the criminal justice system should reduce harsh sentencing, change drug sentencing policies that are old and outdated, and prioritize treatment for SUD-affected individuals. It should offer alternatives to jail and prison, such as the completion of treatment programs. Change starts with learning new skills, and not offering alternatives that encourage behavior change results in no change taking place. Additionally, expanding drug courts and diversion programs would ensure public safety and provide treatment. It is also essential to acknowledge and resolve the issue that black and brown individuals are incarcerated at much higher rates than white populations (Gramlich, 2020). This continues to perpetuate racial injustice within the system.
The justice system should also educate law enforcement at all levels to better understand substance use and mental health disorders, and have judges order evaluation by treatment providers instead of making clinical decisions and ordering certain treatment levels of care themselves. Decriminalizing youth and stopping the sentencing of them as adults is also a step in the right direction, as youth entering adult correctional facilities are only going to worsen and learn antisocial behaviors. Most importantly, it would be prudent to remove barriers to reentry by changing requirements that block opportunities for housing, employment, and occupational opportunities for drug-related offenses.
While some states are making changes, they are also removing almost all accountability for individuals to seek treatment, and accountability is a key driver in accessing treatment. Giving options of a $100 fine or attending treatment will likely result in people paying $100 and not seeking treatment. Most individuals I have treated over the years saw me not because they got up that morning and said, “I must go to treatment,” but because something or someone forced them to be there. One of the reasons for the success of drug courts has been accountability and allowing long-term treatment to address all the needs.
Both systems certainly need a refresh. Having systems work together with updated approaches benefit those we are treating: individuals, families, and communities
Donna Johnson, JD, ICADC, ICCJP, ICCDP-D, LADC, is the director of training for Clare Matrix in Santa Monica, California. She has written numerous magazine articles and has been featured on CBS Atlanta, PBS, CNN, and Fox News discussing various addiction issues. Johnson is the co-author of The Matrix Model for Criminal Justice. She has been a keynote speaker and speaker for numerous state and national conferences, including the National Association for Drug Court Professionals Conference, the National Conference on Addictive Disorders, and the United Kingdom and European Symposium on Addictive Disorders.