Blog
ASAM Editorial Comment
Of 6,900,000 U.S. adults under correctional supervision (incarcerated, paroled, on probation) in 2013, approximately 2,200,000 were confined in jails, prisons, work camps, stockades and brigs. The 2010 Columbia Center on Addiction and Substance Abuse (CASA) report, “Behind Bars II”, gave the following precis indicating drug-associated offenses and actual drug use disorders:
“Of the 2.3* million inmates crowding our nation’s prisons and jails, 85% were substance-involved; 1.5 million met the DSM-IV medical criteria for substance abuse or addiction. Another 458,000 had not met the strict DSM-IV criteria but had histories of substance abuse and were under the influence of alcohol or other drugs at the time of their crime, committed their offense to get money to buy drugs, were incarcerated for an alcohol or drug law violation, or shared some combination of these characteristics. In 2006, alcohol and other drugs were involved in:
• 78% of violent crimes
• 83% of property crimes
• 77% of public order, immigration or weapons offenses and probation/parole violations”
[* Variation from 2010 to 2013 reflects a downward drop in incarceration for that interval - WFH].
In 1854, Dr. John Snow correctly identified the Broad Street pump as the source of an epidemic of lethal cholera infections, in St. James Parish, London. By removing the pump handle, he brought an end to the cholera epidemic in west central London. This week’s links include one relating to the efficacy of injectable long-acting naltrexone in those with opioid use disorder at the moderate-severe level, and another celebrating the raising of the buprenorphine prescription cap to 275/provider. At present, the isolation of inmates serves only to protect the endemicity of the substance use disorders that they suffer; and there is little to indicate that either parole or probation, however enlightened, reduces substance use if not applied in concert with treatment. We may continue to anticipate anguished calls from siblings and parents – and children – of one in every 35 of our adult population, until it is understood that: 1) the absurdly high level of criminality in this country is directly related to the prevalence of substance use disorders; 2) training/education can do little to assure employment for a tribe of former felons or major misdemeanants who face a lifetime of failed criminal background checks (ex-felons: 1 in 8 working-age male adults, 2008, Center for Economic & Policy Research); and finally, 3) criminal justice system substance use disorder (SUD) endemicity is our Broad Street Pump.
Comprehensive SUD treatment is the tool that removes the pump handle.
Editor-in-Chief: William Haning, MD, DFASAM, DFAPA
“Of the 2.3* million inmates crowding our nation’s prisons and jails, 85% were substance-involved; 1.5 million met the DSM-IV medical criteria for substance abuse or addiction. Another 458,000 had not met the strict DSM-IV criteria but had histories of substance abuse and were under the influence of alcohol or other drugs at the time of their crime, committed their offense to get money to buy drugs, were incarcerated for an alcohol or drug law violation, or shared some combination of these characteristics. In 2006, alcohol and other drugs were involved in:
• 78% of violent crimes
• 83% of property crimes
• 77% of public order, immigration or weapons offenses and probation/parole violations”
[* Variation from 2010 to 2013 reflects a downward drop in incarceration for that interval - WFH].
In 1854, Dr. John Snow correctly identified the Broad Street pump as the source of an epidemic of lethal cholera infections, in St. James Parish, London. By removing the pump handle, he brought an end to the cholera epidemic in west central London. This week’s links include one relating to the efficacy of injectable long-acting naltrexone in those with opioid use disorder at the moderate-severe level, and another celebrating the raising of the buprenorphine prescription cap to 275/provider. At present, the isolation of inmates serves only to protect the endemicity of the substance use disorders that they suffer; and there is little to indicate that either parole or probation, however enlightened, reduces substance use if not applied in concert with treatment. We may continue to anticipate anguished calls from siblings and parents – and children – of one in every 35 of our adult population, until it is understood that: 1) the absurdly high level of criminality in this country is directly related to the prevalence of substance use disorders; 2) training/education can do little to assure employment for a tribe of former felons or major misdemeanants who face a lifetime of failed criminal background checks (ex-felons: 1 in 8 working-age male adults, 2008, Center for Economic & Policy Research); and finally, 3) criminal justice system substance use disorder (SUD) endemicity is our Broad Street Pump.
Comprehensive SUD treatment is the tool that removes the pump handle.
Editor-in-Chief: William Haning, MD, DFASAM, DFAPA
