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Who Does, and Who Doesn’t, Get Drug Treatment in Prison

New research finds a racial disparity.
(Photo: Thomas Hawk/Flickr)

(Photo: Thomas Hawk/Flickr)

An Ohio prison yard was reportedly the site of a “free-for-all” earlier this month, when dozens of inmates fought over a package of drugs that had been flown over the prison walls and dropped there by a drug mule drone.

Many news reports about it had a kind of dark humor to them, but the reality behind that debacle is nothing to laugh at. In addition to tobacco and marijuana, the package included enough heroin for about 100 doses, the Columbus Dispatch reported at the time. The paper followed up with a report that the percentage of Ohio state prisoners who tested positive for illegal drug use had increased by 41 percent over the past two years. In 2014, there were about 1,900 inmates in the state prison system who failed random drug tests.

Research has consistently shown how important it is for inmates who come into prison with drug addictions to get treatment behind bars: Drug use in prison that involves needles can spread disease, and cold-turkey withdrawals can lead to overdoses when people get out. But new research also shows that, even when drug treatment is available to prison inmates, not everyone actually takes advantage of it. In fact, the disparity between who does and does not seek treatment often falls among racial lines.

For her recent article in the journal Addictive Behaviors, University of Colorado–Boulder sociologist Kathryn Nowotny looked at survey information gathered in 2004 from state prisons across the country—over 5,000 inmates in 286 prisons. She found that fewer than a half of the inmates who had drug dependency problems had received any kind of treatment at all in their time behind bars. Of those who had, the most commonly referenced treatment was “self-help groups” (as opposed to, say, opioid replacement therapy). And she also found that, when treatment was available, Hispanic inmates who had drug dependency were much less likely than either white or black inmates to utilize it. But why?

Nowotny wrote that she was motivated to examine the racial disparities in drug treatment program use in prisons because there was a dearth of research on this topic. But many other researchers have previously found the same patterns in drug treatment programs out in the communities as well. She notes that—in addition to the widely held consensus viewpoint that people of color have disproportionate contact with every stage of the criminal justice system in America—programs that divert first-time drug offenders out of prison and into alternative treatment have often been shown to favor those defendants “with economic and social resources.” But the disparity she found in treatment during prison sentences was apparent, even when she accounted for all of the other possible factors, like age, gender, marital status, socioeconomic factors, mental health, and criminal history.

In looking for reasons for the disparity, she points to another finding—that white inmates with drug dependency issues are more likely than Hispanic ones to have in-prison drug treatment mandated as part of their sentences. There could also be a much simpler reason for the difference in drug treatment participation. “It is also possibly that language barriers and other indicators of acculturation account for this disparity especially considering that one in five Latinos in prison are foreign born,” she adds. “This hypothesis is bolstered by the fact that no black-white disparities were found.”

A similar study, published in 2013 in the International Journal of Offender Therapy and Comparative Criminology, looked not at state prison inmates but at people being held in county jails that offered drug treatment programs. But the researchers in that study did not find that the differences broke down on more personal lines. They did not find a disparity between jail inmates of different races or ethnicities; here, it was more an issue of age and individual outlook. Younger people were less likely to seek treatment. Men were less likely than women to accept this kind of help. So were people who said they doubted whether they had the discipline or the time to make it stick.

In this scenario, the drug treatment services were optional, and the inmates did not know how long they would be in jail. (Although, the authors point out, the doubters did tend to stay in jail long enough to make use of treatment—111 days, on average.) But this just underscores the significance—and potential efficacy, if done right—of drug treatment in prisons, where inmates know they’ll be held accountable, for the duration of their foreseeable sentences.

And, as Nowotny argues, the motivation to get it right should be clear: “the failure to address addictions in the criminal legal system has been identified as the single most significant reason for arrest and recidivism once released.”

True Crime is Lauren Kirchner's weekly column about crime and criminal justice issues.