A NEW PRESCRIPTION

Investing in substance abuse treatment would take a big bite out of crime

by Joseph A. Califano, Jr., President of the National Center on Addiction
and Substance Abuse at Columbia University.

If, as conservatives and liberals agree, the most basic responsibility of
government is to protect the public safety of its citizens, then the
failure to treat and train the 1.2 million alcohol and drug abusers and
addicts crowding America's prisons is the nation's most egregious display
of public irresponsibility.

In America crime and alcohol and drug abuse are joined at the hip. For two
decades we have been filling prisons with drug and alcohol abusers and
addicts and, without treatment or training, returning them to soci-ety to
resume the criminal activity spawned by their substance abuse. In 1997 more
Americans were in prison, most of them substance abusers, than graduated
from college. This is public policy crafted in the theater of the absurd
and acted out by political demagogues.

Individuals who commit serious offenses such as drug dealing and violent
and property crimes belong in prison. But it is just as much in the
interest of public safety to rehabilitate those who can be redeemed as it
is to keep incorrigibles behind bars. The great disconnect in current
criminal justice policy is that we are not doing well on either track.

Missed Opportunities

More than 1.8 million individuals are behind bars in America: 1,130,000 in
state prisons, 568,000 in local jails and 113,000 in federal prisons.
Eighty percent-1,450,000 inmates either violated drug or alcohol laws, were
high at the time of their offense, stole property to buy drugs, have
histories of drug and alcohol abuse and addiction, or share some mix of
these characteristics. Tragically, among these 1,450,000 inmates are the
parents of 24 million children.

Some 200,000 of these prisoners are drug dealers who don't use drugs. The
remaining 1.2 million are drug and alcohol abusers and addicts. Some would
have committed their crimes regardless of their sub-stance abuse. But
hundreds of thousands are individuals whose core problem is the abuse and
addiction that prompted their criminal activity. They would be law-abiding,
working, taxpaying citizens and responsible parents if they lived sober lives.

The National Center on Addiction and Substance Abuse at Columbia University
estimates that for an additional $6,500 a year, an inmate could be given
intensive treatment, education and job training. Upon release, each one who
worked at the average wage of a high school graduate for a year would
provide a return on investment of $68,800 in reduced criminal activity,
savings in arrest, prosecution, incarceration and health care costs, and
benefit to the economy. If all 12 million inmates with drug and alcohol
problems got such treatment and training (cost: $78 billion) and only 10
percent became sober, working citizens (benefit: $8.26 billion), the
investment would more than pay for itself during their first year of work.
Thereafter, the nation would receive a benefit of more than $8 billion for
each year those released inmates remain employed and drug and crime free.

The potential crime reduction is also big league. Expert estimates of
crimes committed by drug addicts range from 89 to 191 a year. At the
conservative end, successfully treating and training just 10,000 drug
addicts would eliminate 1 million crimes a year. That's the kind of return
on investment to capture the imagination of any businessman. Getting
through to our politicians is another matter.

After three years studying the relationship between prison inmates and
substance abuse, I am convinced that the present system of prison and
punishment only is insane public policy. Despite tougher sentencing laws,
on average inmates are released in 18 months to four years. Even those
convicted of such violent crimes as aggravated assault and robbery are out
in three to four years.

Releasing drug and alcohol addicts and abusers without treatment or
training is tantamount to visiting criminals on society. Releasing drug
addicts is a government price-support program for the illegal drug market.
Temporarily housing such prisoners without treating and training them is a
profligate use of public funds and the greatest missed opportunity to cut
crime further.

Currently we have in America a prison population the size of Houston,
Texas, the nation's fourth largest city. If we don't deal with alcohol and
drug abuse and revamp our system of crime and justice, one of every 20
Americans born in 1997 will spend some time in jail, including one of every
11 men and one of every four black men.

The first step toward sensible criminal policy is to face reality. Prisons
are wall-to-wall with drug and alcohol addicts and abusers. Popular
perceptions of inmates shaped by vivid movie and television images of
playful Bonnies and Clydes, Mafia dons like Marlon Brando who refuse to
deal drugs, and psychopaths like James Cagney in the 1930s gangster films
are ancient history. For eight out of 10 inmates in the 1990s, substance
abuse has been the defining characteristic of their lives and criminal
histories.

Appropriate substance abuse treatment has a higher success rate than many
long-shot cancer therapies. It could certainly help 20 percent of the
substance abusers in prison: That's a quarter of a million criminals who
could be turned into law-abiding citizens and good parents.

Substance abuse and the failure to treat it in the criminal population are
tightly associated with recidi-vism. The more prior convictions an
individual has, the more likely that individual is a drug abuser. In state
prisons, 41 percent of first offenders have used drugs regularly; compared
to 63 percent of inmates with two prior convictions, and 81 percent of
those with five or more. State prison inmates with five or more convictions
are seven times likelier than first offenders to be heroin addicts and
three times likelier to be hooked on crack. Only 25 percent of federal
inmates with no prior convictions are regular drug users, but 71 percent of
those with five of more convictions have histories of regular drug use. The
recidivism-drug abuse relation-ship is similar among the local jail
population.

Alcohol abuse is the first cousin of violent crime. More widely available
than illicit drugs like heroin, cocaine, and LSD, alcohol is a bigger
culprit in connection with murder, rape, assault, and child and spouse
abuse than any illegal drug. Of state prisoners incarcerated for violent
crimes, 21 percent were under the influence of alcohol alone when they
committed their offense; only 3 percent were under the influence of cocaine
or crack alone, and only 1 percent were under the influence of heroin
alone. The situation is similar among federal prisoners.

The common denominator among inmates is not race; it's drug and alcohol
abuse. Blacks are disproportionately represented in prison. Though they
make up only 11 percent of the adult population, they constitute 46 percent
of state, 42 percent of jail and 30 percent of federal inmates. Whites, 76
percent of the adult population, comprise 35 percent of state, 39 per-cent
of jail and 38 percent of federal inmates. However, essentially the same
proportions of black and white (and Hispanic) state inmates, 61 to 65
percent, are reg-ular drug users.

With rehabilitation of the bulk of the prison population dependent on
breaking inmates' substance abuse and addiction, mandatory sentences
- --especially those that require the convict to serve the entire sentence
imposed-- subvert rather than promote the public safety. Corrections
officials need every possible carrot and stick to get inmates into
treatment, including the carrot of reduced prison time for substance
abusing inmates who successfully complete treatment and the stick of prompt
return to jail for parolees who fail to participate in post-release
treatment and aftercare. Mandatory sentences take away any hope of early
release for entering treatment and the threat of immediate return to prison
for failure to stay off drugs and alcohol. Mandatory sentences also deny
judges and prosecutors flexibility to divert substance-abusing defendants
into treatment, drug courts, coerced abstinence and other alternatives to
prison which hold the potential of reducing recidivism and crime.

Religion (notably Christianity and Islam) and spirituality can play a role
often decisive in the rehabilita-tion of many inmates. Inmates and
treatment providers commonly cite spirituality, God, or a Higher Power as a
factor in getting and staying sober, coping with prison life, successfully
reentering the community, and ending criminal conduct. Alcoholics Anonymous
and other 12-step programs stress the role of spirituality in recovery. A
study of New York State inmates in the Prison Fellowship programs founded
by Charles Colson showed that inmates who were active in bible studies were
less likely to commit infractions while incar-cerated and be arrested
during a one year follow-up after release than those who were less active
or did not participate in such programs. Only 14 percent of program
participants were arrested compared to the 41 percent of nonparticipants.

The expense of building and operating prisons is the 800-pound gorilla in
most state budgets, with spending rising at a breakneck pace, up 28 percent
in 1996, compared to a three percent increase in Medicaid spending. That
year Americans paid $38 billion in taxes to build and operate 4,700 prisons
1,403 state, 82 federal and 3,304 local.

Politicians camouflage the failure of their punishment-only prisons by
huffing and puffing tough rhetoric. Each year they pass tougher sentencing
laws, build more prisons and hire more prison guards. These governors,
presidents and legislators are like a chorus of children reciting together,
"If all the king's horses and all the kings men can't put Humpty Dumpty
back together again, then give us more horses and give us more men"

Recently politicians have rushed to cite reductions in crime as their
success story. There has been a significant decline in crime in most cities
and states in America. But most of that drop appears due to the lower
number of drug and alcohol abusers and addicts on the street, an assessment
shared by many street ethnographers who survey conditions by talking to
police, drug dealers, and addicts. In turn this decrease is also due to the
increased numbers of substance abusers behind bars, thanks to stepped-up
law enforcement and more prison sentences.

But, politicians beware. Though you've put lots more drug and alcohol
addicts and abusers in prison, they will be coming out, sooner than you
think. Thus, a critical component of sustaining this lower crime rate is to
get as many of these incarcerated addicts and abusers as possible in
recovery. Indeed, failure to do so will be the greatest missed opportunity
to continue to drive the crime rate down and enter the next millennium with
enhanced public safety.

Putting resources behind the rhetoric of rehabilitation in the 1990s
requires a sea change in the way Americans think about prisoners and
prisons. It will also call for a genuine display of courage from our
nation's political leaders to convince citizens to invest tax dollars in
the treating, educating and training of offenders. Drug Czar General Barry
McCaffrey has begun to provide some cover to our politicians. Building on
the report of The National Center On Addiction and Substance Abuse at
Columbia University, Behind Bars: Substance Abuse and America's Prison
Population, McCaffrey called a conference of treatment experts in
Washington to produce a consensus on the effectiveness of treatment and
training in prisons. He plans a conference of state legislators and others
to promote the idea of treating drug and alcohol addicts who commit crimes.
Politicians who want to further reduce crime and the costs of incarceration
would do well to take McCaffrey's political cover to convince citizens that
treating and training substance abusing offenders is not coddling
criminals; it is opening a second front in the war on crime for their own
protection.

If Christian compassion won't move our citizens to invest the resources
needed to rehabilitate drug and alcohol abusing offenders, then maybe the
realization that they are protecting their own lives and property will. By
opening in the nation's prisons a second front in the war on crime, we will
save billions of dollars, make our streets and homes a lot safer and
reclaim thousands of individuals to lives as responsible parents, hard
workers, taxpayers, and law-abiding citizens.

Checked-by: Mike Gogulski