Prisonization effects and reentry dilemmas

Seth Ferranti has been in recovery for 10 years and is nearing the end of a 25-year prison sentence.  He writes articles about addiction and incarceration for The Fix, a popular online news source about addiction and recovery.

Ferranti’s stories are compelling (and sometimes shocking) because he’s an insider. He has seen how many inmates struggle with substance use disorders (SUDs) and how SUD treatment works or doesn’t work in the criminal justice (CJ) system.  By publishing books and articles as an incarcerated person, he shines a light on certain realities: that drugs flow abundantly in prison and inmates have devised ingenious ways to smuggle, make and trade substances and equipment.

Two big-picture facts stand out from Ferranti’s writings:

  • There are significant and unique barriers to recovery in CJ settings
  • Providing access to treatment is a serious challenge for the CJ system
Ferranti's columns are all archived at TheFix.com

Ferranti’s columns are archived at TheFix.com

However, Ferranti himself attributes his recovery to doing time in prison.  And as state budgets strain under the weight of massive CJ populations, improving treatment quality and access, as well as establishing effective community connections that support long-term recovery for formerly incarcerated people are areas ripe for improvement.

In an ongoing series on SUDs in criminal justice settings, IRETA Blog will look more deeply at some of these opportunity areas and share practical solutions on varying scales.  

The numbers

The numbers, as we know, are high.

SUD prevalence in jails: According to a 2002 Bureau of Justice Statistics (BJS) survey on inmates and drug use, 68% of men and women inmates in local jails were dependent on or abusing drugs or alcohol in the year preceding incarceration.

Trends in substance-involved incarceration:  A 2010 report by the National Center on Addiction and Substance Abuse at Columbia University (CASA) shows that the U.S is imprisoning an increasing number of substance users. Between 1996 and 2006, as the U.S. population rose by 12 percent, the number of adults incarcerated rose by 33 percent to 2.3 million inmates, and the number of inmates who were substance involved shot up by 43 percent to 1.9 million inmates.

Co-occurring disorders:  Another BJS study from 2006 noted that more than half of all state prison and jail inmates have a mental health problem and, of those, approximately 75% of people in jail or prison with mental health problems also have SUDs, which put them about 20 percentage points higher than inmates without mental health problems.

The sheer number of people in CJ settings that are dealing with SUDs can pose a challenge to individual recovery.  Prison culture and the process of prisonization is another barrier.

What is prisonization?

We hesitate to refer to the process of coming home from prison as “reentry.” REenter means “to enter again” and a majority of people we work with were never a part of mainstream institutions…

Prisons have their own cultures. Underneath the antiseptic surface of official rules, regulations, and roles lies a subculture that gives meaning and structure to the everyday actions and interactions of inmates. As do communities on the outside, prison subculture has its own power structures, bartering and trading systems, caste/class hierarchies, and codes of belief and conduct.  They are self-perpetuating and normalizing; in essence, once a person is acculturated, prison life is simply everyday life. It becomes difficult to imagine how behaviors, routines, and interactions might be otherwise.

Violence is at the knotty heart of prison culture. Many inmates experience physical, sexual, and psychological abuse upon entry and throughout their time served. Such trauma (and subsequent behavior to prevent being retraumatized) becomes expected and normal. The effects of becoming more and more institutionalized during incarceration—also known as “prisonization”—include:

  • losing independence and autonomy
  • developing hypervigilance and distrust
  • withdrawing emotions and empathy
  • isolating from others
  • participating in the exploitation of others, especially those perceived as weaker
  • losing a sense of self-worth and respect

The effects of prisonization stand in stark contrast to SAMHSA’s 2009 Guiding Principles and Elements of Recovery-Oriented Systems, which describe an environment that supports recovery as one that:

  • encourages individuality
  • promotes accurate and positive portrayals of psychiatric disability while fighting discrimination
  • focuses on strengths
  • uses a language of hope and possibility
  • offers a variety of options for treatment, rehabilitation, and support
  • supports risk-taking, even when failure is a possibility
  • actively involves service users, family members, and other natural supports in the development and implementation of programs and services
  • encourages user participation in advocacy activities
  • helps develop connections with communities
  • helps people develop valued social roles, interests and hobbies, and other meaningful activities

Thus, the principles that contribute to successful and ongoing recovery utilize the very qualities that prisonization systematically destroys.  And, in addition to the deleterious effects of prisonization, there simply isn’t enough access to or duration of treatment for inmates.

Not Enough Treatment

RDAP waiting times

“RDAP Participants and Wait List, 2006-2012”
In many cases, the number of prisoners wait-listed exceeds those participating.
(Click on the image to enlarge)

According to a 2012 Government Accountability Office (GAO) report, of over 90,000 federal prisoners, only a third receive treatment.  Residential Drug Abuse Program (RDAP) has a waiting list of 51,000 prisoners, who often don’t receive treatment until they are 28 months from release, despite possible years of substance abuse and addiction while incarcerated.

In 2006, the CASA estimated that of the 1.5 million inmates with SUDs in federal, state, and local prisons, only 11.2 percent received any type of professional treatment, including treatment in a residential facility or unit (7.1 percent), professional counseling (5.2 percent) or medication-assisted treatment such as methadone, Antabuse or naltrexone (0.2 percent). Less than one percent received detoxification services.

Reentry challenges

Prisoners often don’t receive the services they need after release, either.  In 2006, according to CASA, only “35.4 percent of conditionally released offenders with SUDs received any form of addiction treatment; women were likelier to receive treatment than men (55.8 percent vs. 29.0 percent).”

One respondent to an article from The Fix describes issues facing prisoners after release that result from the lack of structural support:

The problem when you leave jail is that you are only prescribed enough for one week of your medication, and it takes a lot longer than one week to get back on your feet after prison. Those who depend on psych meds […] often self-medicate with street drugs or alcohol in place of the prescribed drugs […] that they are no longer receiving outside of jail – [this] will cause a relapse, and [they] often commit […] crimes that got them in jail in the first place because they are addicts who also need to be medicated for legitimate disorders. 

And many formerly incarcerated individuals need support not to “return to society,” but rather to find a place in it for the first time.  As Eddie Ellis, founder of the Center for NuLeadership on Urban Solutions, explains:

We hesitate to refer to the process of returning home from prison as “reentry.” Reenter means “to enter again,” and a majority of the people we work with were never a part of mainstream institutions, functional families, the legal job market, or a supportive faith community in the first place. So for them it’s not a case of reentry but of coming into an entirely new situation.

What emerges from the statistics and stories is a bleak portrait of our CJ system and the ways it fails to effectively address SUDs.  Per capita, the United States uses more illegal drugs than any other country in the world; we also imprison a greater proportion of our population.   The size of the problem is enormous and there is lots of room for improvement.

Next up: Proposed solutions to treatment problems from experts on the CJ system

Recommended Resources

Personal perspectives

Seth Ferranti’s website, Gorillaconvict.com and his new book, Gorilla Convict, a compilation of his writing about prison gangs, the mafia, hip-hop and hustling

The Run-On Sentence: Eddie Ellis On Life After Prison in The Sun Magazine (2013)

The No-Help Cycle: Jail Fails Addicts on The White Noise, a Scientific American Blog (2013)

Research and Policy 

From Prison to Home: The Effect of Incarceration and Reentry on Children, Families, and Communities by Craig Haney (2001)

Behind Bars II: Substance Abuse and America’s Prison Population by the National Center on Addiction and Substance Abuse at Columbia University (2010)

 Treatment Guidance

Substance Abuse Treatment FAQs by the Federal Bureau of Prisons

TIP 44: Substance Abuse Treatment for Adults in the Criminal Justice System by SAMHSA (2005)