The House That Drugs Built

Eugene Jarecki’s documentary.

The following quotes have been excerpted from "The House I Live In," the recent documentary about drug addiction and law enforcement written and directed by Eugene Jarecki.


“We like to look at the war on drugs as black hats and white hats, and good guys and bad guys, and victims and offenders. And on the ground, it’s a lot more mixed up than that.”
—Criminal justice professor

“There’s no question that there was a passion with which the early narcotics enforcement culture pursued black America, even though the addict population was always distinctly biracial.”
—TV producer

“Because they’re addicts, they find themselves committing the same crime that just put them in jail, say, a week or so prior.”
—Police officer

“We’re locking up everybody just because we’re mad at them. We need to lock up people that we’re afraid of.”
—Drug offender in prison

“There are more African Americans under correctional control today than were enslaved in 1850, a decade before the civil war."
—Writer, historian

“Sometimes I think you can trace any crime you want to drugs.”
—Police officer

“Everybody involved hates what’s going on.”
—Attorney

“Today the average person I sentence in a drug case is a non-violent blue collar worker who lost their job and then turned to manufacturing methamphetamine to support their habit. And we treat them like they’re kingpins.”
—Federal court judge

“People want to lock people up and then when their sentence is over, they expect them to be reformed, or a different person. If you haven’t given them skills or trained them, how can they be?”
—Corrections officer

“Nobody respects good police work more than me. The drug war created an environment in which none of that was rewarded.”
—TV writer

“I don’t think people fully understand, in the inner city, these kids are making rational choices.”
—Journalist

“Historically, anti-drug laws have always been associated with race.”
—Historian

“Prisons are almost a self-fulfilling prophecy. You build a bed, they fill the bed. It starts sucking in money at an astronomical rate. And it just grows and grows of its own accord.”
—Corrections officer

“Whenever you have a new drug introduced in society, you can say incredible things about that drug, and people will believe you.”
—Psychology professor

“I’d like to see empirical evidence be used in our shaping of public policy.”
—Ex-addict

The Undiagnosed Epidemic of Incarceration

Prison once again a place for addicts and the mentally ill.

Readers may remember the dark day of January 1, 2008, when the U.S. set an all-time record: One out of every 100 adults was behind bars. That’s more than 2.3 million people. That’s 25% of all the prisoners in the world—and the world includes some very nasty nations. What gives?

You know the answer: drug crimes. Can it really be a coincidence that over the past 40 years, ever since President Richard Nixon first declared war on drugs, the number of people housed in U.S. prisons has gone up by more than 600%? Are we really just that much more vicious and larcenous than we used to be? 600% more unlawful than we were as a people in 1971? Last month, a group of medical professionals from the Division of Infectious Diseases at Brown Medical School, and the Center for Prisoner Health and Human Rights, both in Providence, Rhode Island, co-authored an article for the New England Journal of Medicine entitled “Medicine and the Epidemic of Incarceration in the United States.” The investigators conclude that the explosion in the prison population is a direct result of “our country’s failure to treat addiction and mental illness as medical conditions. The natural history of these diseases often leads to behaviors that result in incarceration.” Packed prisons are also the result of a broader movement over the past 40 years to shift the burden of care for addiction and mental illness over to the prison system. “Deinstitutionalization of the mentally ill over the past 50 years and severe punishment for drug users starting in the 1970s have shifted the burden of care for addiction and mental illness to jails and prisons,” the authors argue.

Do the social costs of this massive transfer of addicts and the mentally ill to the U.S. prison system outweigh the benefits? According to the NEJM article by Josiah D. Rich and co-workers, “more than 50% of inmates meet the DSM-IV criteria for drug dependence or abuse, and 20% of state prisoners have a history of injection-drug use.” Rich estimates that up to a third of all heroin users pass through the criminal justice system each year. These figures are shockingly high, compared to the general population, even allowing for a higher level of drug use among the criminal population.

“The largest facilities housing psychiatric patients in the United States are not hospitals but jails,” they write. “More than half of inmates have symptoms of a psychiatric disorder… yet correctional facilities are fundamentally designed to confine and punish, not to treat disease.” Furthermore, as most people are aware, the punishment is not meted out equally: “By middle age, black men in the United State are more likely to have spent time in prison than to have graduated from college or joined the military and they are far more likely than whites to be sent to prison for drug offenses despite being no more likely that whites to use drugs.”

And there is one aspect of the sorry situation that receives almost no attention at all: Most prisoners are eventually released. This post-release period, says the NEJM article, “presents extraordinary risks to individuals and costs to society.” In the first two weeks after release, former inmates are 129 times more likely to die from a drug overdose than the average man or woman on the street. They are 12 times more likely to die, period. And here’s a nice touch: Most of them don’t have Medicaid or other medical insurance, and there is usually no primary care follow-up to assure that they have access to affordable medications, if they need them. Inevitably, these are among the people who make the local emergency room their primary care facility, at great cost to everyone involved.  As the article states: "Addressing the health needs of this vulnerable population is thus not only an ethical imperative, but also of crucial importance from both a fiscal and a public health perspective."

State spending on correctional institutes is now the second fastest growing sector of government spending, after Medicaid. According to the authors, five states now spend more on prisons than they spend on higher education. “Locking up millions of people for drug-related crimes has failed as a public-safety strategy and has harmed public health in the communities to which these men and women return.”

The authors make it clear that, for addicts, drug and mental health treatment programs are humane and sensible alternatives to incarceration. They are also cost-effective: In Rhode Island, for example, the price for putting someone behind bars for a year is $41,000—or $110,000, if we are talking about the new super maximum-security facilities. Why haven’t politicians seized on all of this as a budgeting issue; as a cost-effective way to address drug and alcohol addiction without clogging up the criminal justice system, and creating embarrassing rates of incarceration? The authors have an answer: the fear of being tagged as “soft on crime.” If addiction is a craven failure of will power leading to the violation of social norms, as so many citizens seem to think, than prison is where addicts belong. The result: political pandering on the drug issue, by politicians suffering from a craven failure of will.


Here is where President Obama’s Affordable Care Act could really end up making a difference. Former prisoners will have a good shot at health coverage, and a policy that links together community health centers and academic medical centers could radically improve care during the critical post-release period. As Rich and colleagues argue: “Such access could redirect many people with serious illnesses away from the revolving door of the criminal justice system, thereby improving overall public health in the communities to which prisoners return and decreasing the costs associated with reincarceration due to untreated addiction and mental illness.”

Rich JD, Wakeman SE, & Dickman SL (2011). Medicine and the epidemic of incarceration in the United States. The New England journal of medicine, 364 (22), 2081-3 PMID: 21631319

Pic http://scrapetv.com 

Rehab as Punishment

Why Cambodians, Chinese, and Vietnamese shun treatment—if they can.

The term “drug rehab” usually means one of two things to Americans: Either a genuine, if not always effective, clinic for drug withdrawal, counseling, and follow-up; or else a touchy-feely form of group therapy and 12-step religiosity. What we don’t expect drug rehab to mean is beatings, forced labor, detention without appropriate treatment, or electric batons.

Start with China. A New York Times report by Andrew Jacobs documented the fate of as many as 500,000 Chinese citizens held at government-run drug rehabilitation centers. “Detentions are meted out by the police without trials, judges or appeals,” Jacobs wrote. “Created in 2008 as part of a reform effort to grapple with the country’s growing narcotics problem, the centers, lawyers and drug experts say, have become de facto penal colonies where inmates are sent to factories and farms, fed substandard food and denied basic medical care.”

It has been a long-standing tradition in China and Russia to send addicts to labor camps, along with political dissidents. Change has been promised in China, but thus far there is no evidence of the new community-based rehabilitation the government has proposed. “In China,” said one addict, “to be a drug addict is to be an enemy of the government.”

In Cambodia, according to a report in The Nation by Joseph Amon, the director of health and human rights for Human Rights Watch, police have rounded up men, women, and children in “street sweeps” and placed them in detention facilities without legal consultation. As in China, writes Amon, treatment in Cambodian rehab facilities “consists of military drills, hard labor and forced exercise. Detainees are forced to work and exercise to the point of collapse, even when they are sick and malnourished. These centers offer no medically appropriate treatment such as cognitive behavioral therapy, psycho-social support (counseling, for example) or opiate substitution therapy. As one former detainee explained, his centre was ‘not a rehab centre but a torture centre.’”

The government of Cambodia routinely denies the charges. As Amon argues, “Individuals who use drugs do not forfeit their human rights, and the Cambodian government should not create detention centers that are exempt from the protections afforded to all. “

In Vietnam, 600 addicts broke out of a state-run rehabilitation center in Haiphong and made a run for it. According to Foreign Policy magazine, they were fleeing a similar collection of “treatment” options such as beatings and years of illegal detention in the government’s 100 drug facilities. Along with Malaysia and Thailand, and Laos, Vietnam has opted for “get-tough” policies over evidence-based treatment. Even worse, the policies themselves resemble the practices inflicted on southern chain gangs in early 20th Century American prison farms.

The irony of the great Vietnamese rehab escape is that the patients may have much better luck on the outside. Amon of Human Rights Watch reports that Haiphong “is one of three [cities] in Vietnam that is piloting the use of methadone to manage opiate addiction, the preferred approach in most developed countries.”

Photo Credit: http://www.hrw.org/

Drug Addicts Punished in New York Prisons

Drug offenders get “the box” instead of treatment.

The common practice of placing drug addicts in “disciplinary segregation” for drug use violations in New York state prisons has drawn fire from Human Rights Watch. The international human rights group issued a report condemning the practice of placing addicts in “the box” and denying them treatment for their drug dependence, calling it “cruel, inhuman, and degrading treatment.”

In the report, entitled “Barred from Treatment: Punishment of Drug Users in New York State Prisons,” Human Rights Watch notes that even addicts who are allowed to seek treatment face major delays “because treatment programs are filled to capacity.” New York State Assemblyman Jeff Aubry, chair of the State Committee on Corrections, told the investigators: “Denying treatment to inmates who suffer from a drug dependency is illogical and counterproductive to the goal of rehabilitation.”

Some of the findings in the report are shocking: “Despite overwhelming evidence that medication-assisted therapy is the most effective treatment for opiate addiction, the majority of New York State prisoners dependent on heroin or other opiates have no access to methadone or buprenorphine.” Furthermore, the state’s Department of Correctional Services “has conducted few evaluations of its own treatment programs.” Prison officials have estimated that as many as eight out of ten inmates have substance abuse problems. A National Institute of Drug Abuse (NIDA) study earlier this year, covered in a previous post, estimated that only one-fifth of the nation’s inmates needing formal treatment are able to get it.

The report comes just as New York legislators have agreed to revamp the so-called Rockefeller drug laws, which are among the strictest in the nation. “Reforming the Rockefeller drug laws to prevent drug users from being sentenced to long prison sentences is critically important, said Megan McLemore, a researcher with Human Rights Watch. “But timely and effective programs must be available to serve the inmates still in prison.” McLemore said in a press release that “discipline should be proportionate to the offense, and should never prevent prisoners from getting the treatment they need.”

As a prisoner at Attica told Human Rights Watch, “Here is a notice telling me ‘it could be a long time’ until I get into treatment again. There’s plenty of room for me in the box, but not in a program.”

Photo Credit: ACS blog

addiction drugs

Drug Addiction Goes Untreated in Prison

Only 20% of addicted inmates get rehab.

Among the many ironies of the American War on Drugs, the situation of drug abusers in prison ranks high on the list. Despite decades of research showing that drug treatment can be effective, the federal government has failed to offer it consistently, on demand, for prisoners who need rehabilitation. The National Institute on Drug Abuse estimates that only one-fifth of inmates needing formal treatment are able to get it.

Why aren’t imprisoned drug addicts getting treatment, instead of ready access to a continuing supply of whatever they are addicted to? “Addiction is a stigmatized disease that the criminal justice system often fails to view as a medical condition,” says the report’s lead author, Dr. Redonna K. Chandler, chief of NIDA’s Services Research Branch. “As a consequence, its treatment is not as available as it is for other medical conditions.”

The report, published in the Journal of the American Medical Association (JAMA) found that roughly half of all prisoners suffer some degree of drug dependency. “Treating drug abusing offenders improves public health and safety,” asserts co-author and NIDA director Dr. Nora D. Volkow, citing increased risk of infectious diseases like HIV and hepatitis C among addicts. “Providing drug abusers with treatment also makes it less likely that these abusers will return to the criminal justice system.”

While the high cost of treatment is often cited as a reason for its general absence from the prison infrastructure, Chandler says the cost benefits of treating drug-involved offenders is obvious: “A dollar spent on drug courts saves about $4 in avoided costs of incarceration and health care; and prison-based treatment saves between $2 and $6.”

Adds Volkow: “Viewing addiction as a disease does not remove the responsibility of the individual. It highlights the responsibility of the addicted person to get drug treatment and society’s responsibility to make treatment available.”

Photo Credit: www.thecyncom