I hosted a television show interviewing former offenders who fought their addictions and won. They were an inspiration. They were examples of drug treatment working. I asked them why so many of their peers fail. They told me that they had demons they could not control.
Before the show, we discussed addiction and what it really means. They told me a story where heroin laced with other drugs was killing addicts and sending many to the emergency room in Washington, D.C. During a police chase, the dealer threw out a large quantity of the drugs. The city issued a notice asking people to help find the packages before others died or became sick.
That night, there was a multitude of addicts in the neighborhood looking for the drugs for personal use. “That’s addiction,” said the guests. “That’s what you’re dealing with. It’s overpowering to the point where nothing else matters. That’s why addicts go through treatment multiple times. Unless the system forces treatment, many don’t want it.”
I spoke at length with drug treatment specialists who told me that many offenders would rather do prison or jail time than attend drug treatment. “Drug treatment means examining the reasons why they do drugs, which leads to an examination of their lives and trauma, especially as children. It’s a very painful process. It’s hard to come to grips with being massively mistreated by the people you are supposed to trust.”
Does drug treatment work for some? There’s no doubt that some offenders understand that their lives depend on giving up drugs. Some make the transition. Many (most?) do not. Many offenders resist or avoid treatment unless compelled or strongly incentivized.
California
The Guardian: California arrests thousands on minor drug charges, but few get treatment. “Some defendants chose time in custody over treatment, declined to be evaluated for treatment or missed court dates.” There are also issues of treatment availability.
California prosecutors have filed nearly 20,000 drug possession felony cases under a tough-on-crime measure passed in 2024. But despite promises to get people into services, the vast majority of those arrested have not received drug treatment, state data reveals.
“Proposition 36, a state ballot measure, enacted harsher penalties for minor theft and drug offenses, with proponents pledging the crackdown would lead to “mass treatment to keep people alive, out of jail, and off our streets.”
Case records, however, suggest the state is largely failing to meet the central goal of getting people help and instead conducting mass arrests and incarcerating more people with addiction.
In Prop 36’s first year, less than 1% of drug felony charges resulted in defendants completing treatment programs, data shows (emphasis added). Yes, it’s a relatively new program that needs time to develop, but the article indicates that both counties and targeted offenders are not enthusiastic about the chances for success.
In the first year after Oregon voters approved a ballot measure in 2020 to decriminalize hard drugs, which took effect in February 2021, only 1 percent of people who received citations for possessing controlled substances asked for help (emphasis added) via a new hotline, with some questioning whether the approach is proving too lenient as others say the new system has already had a positive impact by redirecting millions of dollars into facilities to help those with drug dependency issues, reports the Associated Press.
Under Ballot Measure 110, possession of controlled substances is now a newly created Class E “violation,” instead of a felony or misdemeanor. It carries a maximum $100 fine, which can be waived if the person calls a hotline for a health assessment.
Out of roughly 2,000 citations issued by police in the year after decriminalization took effect, only 92 of the people who received them called the hotline by mid-February, and only 19 requested resources for services.
Almost half of those who got citations failed to show up in court.
Meanwhile, state health officials have reported 473 unintentional opioid overdose deaths from January to August 2021, the vast majority of those occurring after decriminalization took effect. The count is nearly 200 deaths more than the state saw in all of 2019 even as opioid overdose visits to emergency rooms and urgent care centers also continue to rise.
Addiction and Related Conditions Summarized
The following is a quick summation of offenders and addiction and mental health issues within the offender population:
54 Percent Have A Serious Brain Injury
“Through a project that began five years ago, researchers have screened 4,100 people in jail, on probation or assigned to drug courts in Denver and five other counties to find out how many have traumatic brain injury — an impairment that could impact the likelihood of their return to the criminal justice system.” “The results were stark: 54 percent had a history of serious brain injury, compared with 8 percent of the general population,” Denver Post.
Most Offenders Have Mental Health Issues
Those dealing with the offender population often describe many as “Having a chip on their shoulder the size of Montana.” Hostility is often an everyday trait.
We’ve known since a Bureau of Justice Statistics self-report study that more than half of all prison and jail inmates have mental health problems. These estimates represented 56% of state prisoners, 45% of federal prisoners, and 64% of jail inmates. Some suggest that the numbers above are a vast undercount. Many are reluctant to admit to mental health concerns.
DOJ Report on Substance Abuse
More than half (58%) of state prisoners and two-thirds (63%) of sentenced jail inmates met the criteria for drug dependence or abuse, according to data collected through the National Inmate Surveys (NIS). Prison managers routinely put the figure at 80 percent.
In comparison, approximately 5% of the total general population age 18 or older met the criteria for drug dependence or abuse, Bureau of Justice Statistics.
Alcohol
According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.1 percent reported that they drank in the past year; 56.0 percent reported that they drank in the past month. 26.9 percent of people ages 18 or older reported that they engaged in binge drinking in the past month in 2015, National Institute on Alcohol Abuse. The vast majority of offenders abuse alcohol. Historically (and criminologically), alcohol is strongly connected to violent crime.
PTSD
There are articles about people who live in high-crime communities having PTSD because of their exposure to violence in their families and communities. High-crime area violence seems to be corrupting; it may influence people who can see violence as a necessary component of life.
Arrests and Drugs
Anywhere from 56 percent (Charlotte) to 82 percent (Chicago) of arrestees across sites tested positive for the presence of some substance at the time of arrest. In 9 out of the 10 sites, 60 percent or more of arrestees tested positive, ADAM and Drug Use at Arrest.
Trauma
Between 75 and 93 percent of youth entering the juvenile justice system annually in this country are estimated to have experienced some degree of trauma, Children and Trauma.
A Rutgers University study showed that more than half (56 percent) of male inmates reported experiencing physical abuse as children, while 47 percent of female inmates reported experiencing childhood sexual abuse. There are studies indicating that the majority of female inmates come from histories of sexual abuse, principally by family members or people they knew as children.
Recidivism
Organizations are stating that state recidivism is being reduced. They say that most people released from prison do not return. See the document for the methodology; it’s mostly self-reports with endless variations of definitions for recidivism.
But the most common understanding of recidivism is based on state data from the US Department of Justice, Bureau of Justice Statistics, stating that two-thirds (68 percent) of prisoners released were arrested for a new crime within three years of release from prison, and three-quarters (77 percent) were arrested within five years.
Within 3 years of release, 49.7% of inmates either had an arrest that resulted in a conviction with a disposition of a prison sentence or were returned to prison without a new conviction because they violated a technical condition of their release, as did 55.1% of inmates within 5 years of release.
A ten-year study from the Bureau of Justice Statistics shows that 82% were arrested at least once during the 10 years following release. Offenders committed well over two million new crimes. About 61% of prisoners released in 2008 returned to prison within 10 years for a parole or probation violation or a new sentence.
Note that 66 percent of male offenders (90 percent of prison inmates) are currently serving prison time for a violent crime, per the USDOJ’s Bureau of Justice Statistics. If you include criminal histories, it could be as high as 80 percent. Federal data suggests that violent offenders recidivate more than others. So if state “recidivism” is being reduced as the source claims, it seems to be a finding of leniency for violent offenders that contradicts much better data from the US Department of Justice.
In my opinion, states “could” be redefining recidivism (basing reoffending totally on felonies and excluding serious misdemeanor by multi-repeat offenders) or greatly easing what many call parole and probation technical violations. Some technical violations (escape, threats of violence, complaints from police or community members, failure to obey stay-away orders from victims, not making restitution, failure to engage in programs) have real implications for a possible return to criminality.
Yes, governors want less spent on corrections.
Conclusions
Most of us who work within the criminal justice field support drug treatment and programs for offenders on a humanitarian basis rather than a modality that will reduce future recidivism. The problem is that most programs for offenders do not work to reduce massive recidivism, according to multiple sources.
We have a review of the literature (over 600 evaluations) funded by the National Institute of Justice of the US Department of Justice stating that most rehabilitation programs don’t work (Peabody College of Education and Human Development, Vanderbilt University). Large-scale reviews of hundreds of program evaluations find that many rehabilitation programs produce modest or inconsistent reductions in recidivism, with most showing no effect.
My assertion that programs for offenders are not working causes immediate pushback from people who insist that they are effective tools. We have debated the efficacy of treatment programs for decades without resolution.
I will suggest that people who advocate for offender programs as they are currently constructed not only ignore multiple sources of reputable data, but they are also causing harm because programs have terrible track records, something that many prison inmates will be the first to acknowledge in very colorful terms.
Rather than admit that the data indicates failure far more often than success, we continue a broken process that fails the people whom we are supposed to assist. Rather than calling for a national program to evaluate dismal results and fix problems, advocates continue to call for more of the same. Within the medical field, this would not be allowed. Proponents of consistently failed medical programs would be banned.
It’s like sending rockets to the moon that blow up on the launch pad multiple times; advocates continue to support bad results. Yes, some programs (drug courts, cognitive behavioral therapy) reduce recidivism a tad (20 percent).
Overall, recidivism rates remain high, often with a majority of released offenders rearrested within several years.
If states really believed that programs dramatically reduced offender recidivism, they would fund efforts that could potentially save them billions of dollars. Why don’t states fund programs? Because the data says they don’t work, or the results are minimal.
From Where Left and Right Both Go Wrong on Crime, provision of mentoring, employment services, and case management for people leaving correctional facilities doesn’t seem to help, according to a trial of over 4,500 participants…. Indeed, as hard as this is to swallow for rehabilitation-minded people…, the study found that those who were randomized to have access to these services had a 21 percent greater chance of being convicted of a new crime in the three years after release.
Despite the study’s focus on employment, those receiving services were, if anything, less likely to land and keep a job. The provision of rehabilitation services may even increase the likelihood that released individuals commit more crimes for unclear reasons. Doleac notes that this study was not a fluke: Another large evaluation generated similar findings with a different package of services.
Unless those with abuse and trauma backgrounds are addressed, it greatly diminishes the chance for rehabilitation. Undoing trauma at the hands of family members and people you knew would take an immense and costly effort.
The vast majority of our discussions about crime, police encounters that go wrong, treatment failures, and recidivism may be partially explained by the fact that the offenders we encounter are very troubled people with brain injuries, PTSD, and mental health issues who self-medicate through drugs and alcohol.
The conditions mentioned above probably explain the chaotic nature of offenders’ lives. It’s equally possible that the root cause of criminal offenders is child abuse that few are willing to acknowledge or address.
We have to come to grips with the fact that drug, alcohol, and mental health treatments are very expensive and have to be administered multiple times before they take effect (if they take effect). Americans may be willing to fund an initial round of treatment. But are they willing to fund endless bites of the apple?
Even in programs that claim minimal success, most participants drop out.
If Oregon and California are examples (there are many others), we may have to compel drug users to enter and succeed at community-based treatment, as problematic as that would be, because most would fail. They seem unwilling to do it on their own via programs.
They believe that their troubled backgrounds require self-medication.
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