California is often regarded as a hotbed of innovation among the fifty states. By no means does this reputation mean that the Golden State has all the answers. Rather, much can be learned from around the nation – particularly when it comes to innovative programs that might show results back here in California. Below you will find specific tactics that have been employed by counties across the U.S. to reduce addiction among their prison populations.
By Charlie Ban.
A spell in the county lockup gives inmates plenty of time to think and some jails give them plenty to think about, as they assess — voluntarily or not — the roles alcohol and drugs have played in their lives with substance abuse treatment programs.
Bureau of Justice Statistics data show that nearly half of jail and prison inmates are clinically addicted to drugs and alcohol, and 60 percent to 80 percent of drug abusers commit a new crime after release from prison. Research by the American Psychological Association indicates a combination of incarceration-based substance abuse treatment programs, paired with post-release aftercare, can significantly affect recidivism rates among those challenged by alcohol and drug misuse.
The Strafford County, N.H. Jail’s therapeutic communities substance abuse program houses 25 people — 15 men, 10 women — in its gender-specific housing units, segregated from the rest of the jail community.
For 90 days, they go through a rigorous schedule, complete with 5:30 a.m. wakeups, classes, group therapy and substance abuse counseling.
“There’s a big focus on clean living and personal responsibility,” said Jake Collins, the jail’s assistant superintendent. “Your bed has to be made a certain way. You can’t be lazy and get through it.”
Collins emphasized that the single-sex nature of the rehabilitation was key.
“Men might not want to share feelings in front of women, and women who were abused by men might be afraid of men similar to those who abused them,” he said. “It also limits the chance for romantic involvement, which can derail other rehab programs.”
Inmates can opt for the substance abuse program while in jail, or they can wind up there as a sanction in the county’s drug court.
“We have a fair number of people who are ready to get treatment,” Collins said. “But people in the drug court slip up, they can wind up here.”
The therapy focuses on the origins of the offenders’ substance abuse problems.
“We don’t spend much time on the ‘this is your brain on drugs’ lessons,” Collins said. “New England has a puritanical ethos about crime and punishment, and that drives a lot of people’s drive to eliminate what caused their problems.”
The Strafford County Jail is a holding facility for the U.S. Marshals Service and houses some federal detainees, all of whom may participate. Collins sees a lot of the value in shortening some inmates’ stays.
“If they complete the therapeutic communities program, we typically move them to community-based programs,” he said. “We tend to feel like they’ve gotten what we can give to them in jail, plus if you can do something positive in 90 (days) instead of keeping them for 365, it saves a lot of money.”
Collins said most of the inmates who go through the program are battling alcohol or heroin addictions. Methamphetamine’s prevalence has decreased following state restrictions on pseudoephedrine sales.
Below the Mason-Dixon Line, Mecklenburg County, N.C. operates an indigent, social-setting detox facility.
“When the police pick someone up and don’t think he needs to go to jail, it’s a place for them to take him and let him ‘sleep it off,’” said Yvonne Ward, program administrator for the county’s substance abuse services. “While they’re here, we encourage them to look into our longer-term treatment options.”
It’s not a place to kick back and relax, though. While it isn’t a medical facility, it has nurses and a medical director on hand. For some patients dealing with alcohol withdrawal, the process can require medical attention.
“You’ll see a lot of seizures with alcohol, and that’s what the substance people are most commonly dealing with here,” Ward said. “Alcohol can be one of the most dangerous drugs and most fatal when they’re coming off of it.
“We practice what medicine we can in our treatment scope, but we do a thorough medical screening to see if they need more involved care. A lot of times, especially with the homeless population, they’re dealing with mental health issues and serious medical issues that have gone untreated for a long time.”
The facility also has staff embedded in the county’s homeless shelters.
A medium-term detox could last five days, depending on the substance. The jail population can mix in here.
“While they’re here, they’re expected to be participating in the activities, work with our case managers and start to plan a course for where they’ll go,” Ward said. “Where they’ll stay, where they’ll get food. We’re always planning ahead.”
They’ll learn strategies for managing triggers and cravings and learning skills to be successful when they leave.
“We focus on long-term independence, but also the support they can look for in the community,” she added.
The 76-bed facility serves between 2,500 – 3,000 people a year. The detox beds run the county $118 per day, and $140 for the 28-day residential program. The state reimburses much of the costs that aren’t supported by Medicaid or disability.
Davis County, Utah sees a lot of meth and heroin users in its Jail Substance Abuse Treatment (JSAT) program.
“Meth is dirt cheap in the West,” said Deputy Scott Manfull. “And you’ll get a lot of people who transitioned from pills to heroin.”
The JSAT program is voluntary. Groups of 10 meet five days a week and receive individual attention from two in-house counselors. They receive screening from the county’s behavioral health department to look for co-occuring mental health issues.
After six months, they transition to a work center until they secure a job on the outside, then report back to a judge every other week. They’re subject to two random drug tests per week. Six months clean will reduce their charges.
It’s after that, Manfull imagines the challenge grows.
“I think a lot of people do well under supervision because someone’s watching,” he said. “When you have to make your own decisions, things get tougher.”
Substance abuse treatment programs are typically led by trained counselors, but Denver County, Colo. is finding success with peer-led groups in its Recovery in a Secured Environment (RISE) program.
“It lends some credibility that some of these peer leaders are people inmates have known from the outside,” said Sheriff Elias Diggins.
RISE also offers peer-to-peer and counselor-led program options in jail pods separated from the rest of the jail population, one each for men and women. Eight rooms in the pod could contain eight people each, though Diggins said the jail makes an effort to limit the RISE pod populations. The men’s population tops out in the 40s and the women’s population in the 20s.
“If the groups get too big, the conversations aren’t as productive,” he said. “We give people a little more elbow room.”
That elbow room in the pods is one of the benefits that come with RISE participation — no lockdowns, exemption from the state’s work requirement for inmates — in part to reward inmates for taking on what Diggins describes as a rigorous curriculum.
“It’s structured every single day, and sometimes that’s too much to handle; we get dropouts,” Diggins said. “It’s a voluntary program, but you have to be up for hard work. Everything they do is geared toward addressing their addictions and getting closer to recovery. It’s not for the faint of heart.”
Not participating — in group sessions or discussions — is grounds for removal.
Diggins said the RISE program, now in its fourth year, shows recidivism rates in the low 40 percents, compared to a 67 percent rate for the general population.
“When they graduate from the program, they sign their name to a wall,” Diggins said. “A lot of them haven’t had the opportunity to graduate from things, so it’s a point of pride.”
It’s an approach Diggins sees as the future of local incarceration.
“As our industry evolves, we’ll find ways to address these root problems that cause people to act out,” he said. “It might not solve everything, but sometimes we can help people save themselves.”