About Substance Abuse Treatment Versus Incarceration in the USA

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Drug abuse, also known as substance abuse, is the pattern of repeated drug use that harms the user or society as a whole. The meaning of the phrase varies depending on how organizations like courts and medical facilities interpret it. Overall, drug use results in addiction, which can cause users to injure themselves in social, physical, physiological, and social ways. Depending on the areas of authority, severe harm to an abuser may carry criminal sanctions. The phrase "drug abuse" refers to using drugs including marijuana, cocaine, opiates, and alcohol among others (Greenfield et.al, 2007). Substance abuse treatment is the process of eliminating substance addiction from an individual to correct behavior, change the perception of drugs and reinstate the normal functioning of an individual without drug influence. There is an effective method of treating substance abuse victims via comprehensive care, facilitated by programs of drug rehabilitation. All the drug rehab programs and center follow a three steps procedure of substance abuse treatment; these are detoxification, individual counseling, and aftercare.

Substance abuse treatment is a correctional action for drug abusers, and incarceration of substance users is another way of correcting addicts. So here is the problem, substance abuse treatment versus incarceration, which is the most effective correctional method in terms considering cost effectiveness, recidivism rates, denial of treatment and ethical considerations? The relationship between substance abuse and incarceration is quite simple; substance abuse implicates in the following offense related to drugs and leading to incarceration. Drug sales or possession offenses, offenses with a direct relationship to a drug such as stealing for the purpose of acquiring drugs and those offenses linked with lifestyles supporting possible engagement in illegal activities such as associating with drug traffickers (Mukku, Benson, Alam & Bailey, 2012). In a bid to enhance substance abuse treatment, the judiciary introduced drug courts, which deal only deal with the non-violent drug addicts, putting them under treatment for even the longest time possible. However, violent crimes and other hard substance abuse offenses are under the local jurisdiction and have consequences such as incarceration.

Substance abuse is a menace affecting all genders, and mostly the youth from the age of twelve years. According to the National Institute on Drug Abuse (NIDA), the ratio of drug abusers is to non-users 1:10, meaning that there is a substance abuser in every ten Americans. Males are mostly affected and incarcerated due to drug offenses, especially those of the age between 20 to 34 years, Black Americans and Latinos. In 2013, a survey by the Substance and Mental Health Service Administration (SAMHSA), showed that approximately 24.6 million people in America were using illicit drugs, from the age of 12 and above.

The numbers in 2013 represented 9.4 percent, same as the previous year and an increase of 0.2 percent from the year 2011. The most abused drug was marijuana with approximately 18.9 million users. Cocaine had approximately 1.5 million users while heroin users were nearly 681000. With the above statistics, it is evident that drug abuse is widespread across all the states in the USA. People of the age of 12 are most affected, where even the most alcohol abusers were the youth of the age between 15 to 17 years ("National Institute on Drug Abuse (NIDA)," 2017). On September 2015, nearly 50% of federal prisoners, approximately 92,000 prisoners, were incarcerated for drug offenses. Should the government focus on substance abuse treatment or incarceration? Some states are embracing drug abuse treatment rather than incarceration. In the year 2000, the state of Maryland focused on treating drug abusers caught with drug-related offenses, the efforts of these changes arose due to support from civil rights advocates, the society, the public and the treatment providers (Volkow, 2008). The move by Maryland saw a decrease in incarcerated individuals by 7% while the number of offenders admitted for treatment rose by 27% between the years 2000 to 2004.

Using Maryland as a case study, there are different stakeholders with the capacity of fighting substance abuse. Civil rights advocates and the community as well established the need for substance abuse treatment rather incarceration. NIDA’s mission is to carry out research on consequences and causes of drug use and using the results and advanced knowledge in science to improve the health of the public and individuals. Such an institution plays a critical role in public awareness on the issue of treatment and incarceration. The National Association of Drug Court Professionals (NADCP) conducted research on the most effective way of correcting drug users. Using its research surveys, NADCP emphasizes that imprisonment has little or no effect on drug abuse. In a recently conducted research, the association discovered that 95% of drug offenders incarcerated in various prisons return to drug abuse after release ("Bureau of Justice Statistics (BJS)," 2017). Therefore, NADCP plays a critical role in the problem by advocating for the use of drug courts that prefer treatment to incarceration. The recommendations from NADCP, an association recognized by the government, are important during the enactment and review of drug abuse policies and laws.

Historical Background of the Problem

As a result of substance abuse, individuals become drug addicts, commit drug-related offenses that are criminal activities according to the law. The solutions to correcting substance abuse are either treatment or incarceration, where a victim commits a criminal offense. The reasons for abusing drugs are many, including peer influence among the youth, poor parenting, poor school achievements, unstable environment at homes and poor relationship with parents among others (Inciardi, Martin & Butzin, 2004). Some people, especially adults, may abuse drugs such as alcohol due to high work level stress and personal issues such loss of jobs.

The history of substance abuse treatment dates back in the 1750s to early 1800s when there was a rise of alcohol consumption. In the 1750s, the different societies in the US mutual aid societies to fight alcohol. During this time, the media and especially newspapers published articles criticizing alcoholism. In the early years of the 19th century, Dr. Benjamin Rush suggested for the care of drunkards in a rehabilitation house known as ‘sober house.' Up to the late 1850s, alcohol was the commonly abused drug till 1864 when the government introduced inebriate asylums for the purpose of treating alcoholism and other emerging drugs such as cocaine, morphine, and opium among others. All through the 20th century, the US government was fighting alcohol as the most abused drug, creating agencies and counseling platforms to rehabilitate the substance abusers ("Significant Events in the History of Addiction Treatment and Recovery in America," 2017). For example, in 1944 the National Committee for Education on Alcoholism was formed, informing the public that alcoholism is a disease that is treatable. The committee, currently known as the National Council on Alcoholism and Drug Dependence (NCADD), created public awareness on alcoholism via campaigns. Most importantly, NACDD encouraged addicts to get admission in hospitals for acute detoxifications.

The history of incarceration of drug-related offenses began in the 19th century where the most common drug was alcohol. Imprisonment of offenders follows the certain laws concerning drugs put in place by the government. Offenses such as possession and sale of drugs were punishable by the law. The two corrective actions of incarceration and substance abuse treatment bring the national wide issue of war on drugs. The war on drugs began in 1971, with the declaration by President Nixon. Nixon pushed hard for mandatory sentences for drug offenders and enhanced drug control via increasing the federal agencies of drug control. During his presidency, marijuana was the highly abused drug, forcing Nixon to have marijuana as the most restrictive drug. The year 1986 marked the beginning of proper incarceration for drug-related offenses after Congress passed the Anti-Drug Abuse Act. This Act introduced new minimum and mandatory sentences for drugs. The act introduced a punitive system for substance users, reversing the federal system of supervising and releasing individuals under rehabilitation. Since then, substance abusers violating the act and committing criminal activities related to drugs face imprisonment.

The period between the 1980s and 90s marked most incarcerations due to drug-related offenses. By 1980, there were only 50,000 prisoners serving for drug offenses; the number grew to 400,000 in the year 1997. The war on drugs experienced an escalation with every new president in the USA. During his campaigns, Bill Clinton supported treatment rather than incarceration; he, however, took the war to its extremes disregarding treatment and seeking more punitive measures. When George Bush became the president of the United States, the war on drugs continued with over 40,000 annual raids on misdemeanors and other offenses for non-violent drug abusers. From the historical background, the problem remains on whether to punish drug offenses with incarceration or treatment.

The society contributes to substance abuse in many ways, and parenting influence is a great factor. Parents who smoke bhang, tobacco and imbibe alcohol pass their influence to their children. For example, children exposed to smoke while young will have the urge to smoke tobacco or bhang (Marlowe, 2003). Also, the family structures in the society, including low levels of education status increase the prevalence of substance abuse. The youth with low education status, do not even know the effects of drugs. Family structures such as single parents and divorced parents contributing to significance drug abuse among adolescent youths. The economic activities and income levels contribute to drug abuse where poor economic activities and low levels of income attract use of cheap drugs (Jiloha, 2009). The beliefs in various societies also affect substance abuse. For example, some societies belief that alcohol reduces the stress levels, others believe that marijuana is a cure and holy herb. Such norms may lead to more and more people abusing drugs.

The impacts of substance abuse have changed from time to time, where in the past decades, the issue of incarceration was on the rise. Currently, the society and the government is embracing the need for substance abuse treatment rather than incarceration of offenders. Incarceration of substance abuse offenders is expensive and costing the government and taxpayers extremely high amounts of financial resources. Due to efforts of the society, research groups and human rights activists, a state such as Maryland changed is routine incarceration practices to substance abuse treatment. From a global view, the problem of drug abuse is widespread and causing so much harm than benefits. However, some states in the United States, such as California allowed the sale, possession, and use of marijuana. In as much as substance abuse is not allowed in most regions of the world, other places have no problem with some of the drugs. The situation shows some changes, from fighting drugs to later allowing the use of specific drugs, through legalization.

Addressing the Problem of Substance Abuse Treatment Versus Incarceration

The table below shows some statistics from NIDA on the annual costs of substance abuse in the United States. The costs relate to illicit drugs, alcohol, and tobacco; the amounts represent money lost in health care and lost work productivity.

Health Care



$130 billion

$295 billion


$25 billion

$224 billion

Illicit Drugs

$11 billion

$193 billion

From the above figures, the cost of substance abuse is quite high. However, substance abuse treatment is cost effective compared to incarceration (Belenko, Hiller & Hamilton, 2013). According to research by NIDA in 2014, the cost of treating an individual was $4,700 while that of incarceration was $24,000. The impacts of treatment include improved workplace productivity, fewer accidents related to drugs and reduced interpersonal conflicts. Treatment is becoming more efficient as more states such as Maryland are embracing substance abuse treatment. Agencies and programs have been formed to deal with the corrective actions for drug abusers. In New York, the Drug Treatment-to-Prison Program (DTAP) is involved in substance abuse treatment ("National Institute on Drug Abuse (NIDA)," 2017). A survey of the participants showed a reduction in recidivism rates by 67% after 24 months of completing the program. The re-arrest rate lowered by 26% after completing the program, more importantly, the cost of treatment for an individual at DTAP was $32,975 far below the incarceration rate at $64,338. According to NADCP, nearly 95% of incarcerated drug offenders resume to substance abuse after release. After release from prison, between 60% to 80% of the incarcerated prisoners commit crimes related to drugs. While in prison, nearly 80% of inmates incarcerated for drug offenses abuse drugs. According to a study in 2009, substance abuse treatment reduces the rates of recidivism (James, 2009). Crime offenders who have gone through treatment program such as rehabilitation are unlikely to face reconvention and re-arrest. However, conducting studies related to recidivism is difficult, though drug abuse treatment changes most individuals and transform them into meaningful people in the society.

The Obama Administration introduced the 2012 National Drug Control Strategy under a drug control agency known as Office of National Control Policy(ONDCP). The strategy was to address public safety and health challenges, including treatment of drug addicts and bringing innovative reforms on drug crime, use, rearrests and incarceration among others. The government introduced the special drug courts, over 2,600 courts in the US by 2012, these courts advocate for substance abuse treatment rather than imprisonment. The drug courts helped over 120,000 offenders annually but arrested for non-violent drug offenses. The government introduced and continuously fund the Drug-Free Communities Program (DFCP), to help prevent substance abuse among the youth ("White House Fact Sheet on U.S. Drug Policy | IIP Digital", 2017). The Affordable Care Act signed in 2010 by the US president encourages substance abuse treatment by creating insurance coverage for drug disorders.

Currently, the government has multiple agencies that help in the control of drugs. The Drug Enforcement Administration (DEA) under the department of justice curbs the smuggling of drugs and trafficking into the country. There are other agencies such as NIDA, Bureau of Narcotics and Dangerous Drugs (BNDD), Center for Substance Abuse Treatment (CSAT) and Special Action Office for Drug Abuse Prevention (SAIDAP) among others. Besides control of drugs and substance abuse treatment, these agencies formulate and enact new policies relating the use and abuse of drugs. There are major campaigns by the media and drug agencies to fight substance abuse.

Above the Influence (ATI) campaign for alcohol and drug prevention started in 2005 under Office of National Drug Control Policy (ONDCP) and other programs. The federal government funded ATI that concentrated on teenagers, reaching them via leisure social media platforms such as Facebook and Instagram (Staff, 2017). Under ONDCP, the government created the National Youth Anti-Drug Media Campaign to prevent and reduce substance abuse among the youth in the US. With the same idea of substance abuse prevention, SAMHSA introduced different campaigns across the states. For example, the agency the Generation Rx Project in Georgia prevents prescribed drugs misuse by the young people of the age between 12 to 25 years. All these campaigns and much more help reduce substance abuse.

Many gaps exist in the war on drugs especially with the enforcement of racially discriminatory drug laws. There is significant evidence proving that some of the laws are biased against the less fortunate and are racially discriminative. Some of these laws portray bias against communities of color. For instance, 14% of drug users are African Americans, where they form 37% of arrestees in drug-related offenses, and 56% of the arrestees get incarcerated for drug-related crimes. The black people spend an average of 58.7 months for drug offenses in federal prisons nearly close to an average period of 61.7 months for the whites serving for violent crimes. Some sentencing laws such as the 100-1 for possession of crack-powder made African Americans spend more time in prisons (Stevenson, 2011). Some of these laws discriminate color communities and others such as the Hispanic people who are at the risk of more prosecution and arrest for drug offenses and crimes than the whites. Drug use is menace running across racial lines, but people of color have the probability of more arrests, incarceration, searches and convictions more than whites. High rates of arrest to the Latinos and African Americans does not necessarily reflect rampant usage and sale of drugs, but drug enforcement laws are targeting communities of color, urban areas, and low-income communities.


Belenko, S., Hiller, M., & Hamilton, L. (2013). Treating substance use disorders in the criminal justice system. Current psychiatry reports, 15(11), 414.

Bureau of Justice Statistics (BJS). (2017). Bjs.gov. Retrieved 1 March 2017, from https://www.bjs.gov/

Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., ... & Miele, G. M. (2007). Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug and alcohol dependence, 86(1), 1-21.

Inciardi, J. A., Martin, S. S., & Butzin, C. A. (2004). Five-year outcomes of therapeutic community treatment of drug-involved offenders after release from prison. Crime & Delinquency, 50(1), 88-107.

James, N. (2009). Offender Reentry: Correctional Statistics, Reintegration into the community, and recidivism. Congressional Research Service, Library of Congress.

Jiloha, R. C. (2009). Social and cultural aspects of drug abuse in adolescents. Delhi Psychiatry J, 12(2), 167-175.

Marlowe, D. B. (2003). Integrating substance abuse treatment and criminal justice supervision. Science & Practice Perspectives, 2(1), 4-14.

Mukku, V. K., Benson, T. G., Alam, F., Richie, W. D., & Bailey, R. K. (2012). Overview of substance use disorders and incarceration of African American males. Frontiers in Psychiatry, 3.

National Institute on Drug Abuse (NIDA). (2017). Drugabuse.gov. Retrieved 1 March 2017, from https://www.drugabuse.gov/

Staff, J. (2017). Teen-Targeted Substance Abuse Prevention Campaign Focuses on Digital, Social Media - Partnership for Drug-Free Kids. Partnership for Drug-Free Kids. Retrieved 1 March 2017, from http://www.drugfree.org/news-service/teen-targeted-substance-abuse-prevention-campaign-focuses-on-digital-social-media/

Significant Events in the History of Addiction Treatment and Recovery in America. (2017). Williamwhitepapers.com. Retrieved 1 March 2017, from http://www.williamwhitepapers.com/

Stevenson, B. (2011, January). Drug policy, criminal justice, and mass imprisonment. In Global Commission on Drug Policies, working paper prepared for the first meeting of the Geneva Commission. Available at: http://www. globalcommissionondrugs. org/wpcontent/themes/gcdp_v1/pdf/Global_Com_Bryan_Stevenson. pdf, Accessed (Vol. 24, p. 2013).

Volkow, N. (2008). Substance Abuse Treatment and Public Safety. The Justice Policy Institute, 17. Retrieved from http://www.justicepolicy.org/images/upload/08_01_rep_drugtx_ac-ps.pd

White House Fact Sheet on U.S. Drug Policy | IIP Digital. (2017). Iipdigital.usembassy.gov. Retrieved 1 March 2017, from http://iipdigital.usembassy.gov/st/english/texttrans/2012/04/201204174016.html#axzz4a0sFTsfw

March 15, 2023

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