Addiction Treatment Programs in Prison

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

January 17, 2019

The Federal Bureau of Prisons recognizes that addiction is a disease that requires treatment. Though the number of inmates receiving treatment for addiction is still low, the Bureau does incorporate both short-term (12-week) Cognitive Behavioral Therapy (CBT) as well as an intensive residential program involving both CBT and a social-community model designed to transition former drug offenders back into society upon their release. The Residential Drug Abuse Program (RDAP) includes vocational training and other educational opportunities in addition to treatment services for drug and alcohol addiction.

Additionally, the Bureau offers a transitional, supervised release program under the heading Community Treatment Services (CTS), providing ongoing counseling to reduce recidivism rates during this vulnerable period.

Following guidelines for evidence-based treatment from the Center for Substance Abuse Treatment (CSAT), the Federal Bureau of Prisons is working to identify the issues and treatment types that will benefit prison populations, reducing recidivism rates. It’s increasing the effectiveness of these programs by addressing some of the factors in relapse are specific to prison populations.

Prison Relevant Addiction Treatment Issues

The prison inmate population is in the millions, with 75 percent of prison populations suffering from a substance use disorder with or without a co-occurring mental disorder. Of those imprisoned for a violent crime, nearly half are considered regular drug offenders.

Prisoners tend also to suffer a higher degree of health-related issues, exhibit antisocial behaviors and face social stigmatization both in and outside of prison, come from a background of family dysfunction, drug exposure, and addiction, and experience a level of trauma associated with incarceration. These and other factors make relapse rates higher and treating prison populations more challenging.

Prison populations tend to suffer a higher risk of:

• Co-occurring mental disorders
• Ongoing health issues
• Social stigmatism
• Antisocial behaviors
• Family dysfunction
• Drug exposure and addiction
• Trauma
• Relapse

Programs that identify co-occurring mental disorders and past trauma demonstrate a greater rate of success than those that seek only to treat the addiction. These programs incorporate cognitive behavioral therapy (CBT), an approach designed to identify past traumas and work to alter perceptions and responses to these events.

Some prisoners, like sex offenders, face a greater risk of stigmatization and risk of victimization while still incarcerated. Treatment of these types of offenders is specific, and a scattershot treatment approach is sometimes employed, so that no prisoner may be singled out and targeted for his offense while seeking treatment for addiction.

Effective In-Prison Treatment Types

Cognitive behavioral therapies used in conjunction with education and social training are more successful drug treatment programs in reducing relapse rates than deterrent programs, especially among prison populations. One part of the success of these programs is that they not only identify risk factors that contributed to the addiction in the first place but work to address and correct behaviors associated with these factors. They also help an individual develop coping strategies to handle past and future stress and trauma.

Studies indicate CBT is effective in both juvenile and adult prison populations. Different approaches apply CBT under different headings like “Aggression Replacement Therapy” or “Reasoning and Rehabilitation,” but apply the same underlying principles of empowering the individual to change how they respond to their environment.

This broad spectrum approach is ideal for populations who have experienced a higher rate of trauma, inside or outside of prison, have a high rate of drug exposure, and who have minimal coping skills to manage anger, cravings, and other behaviors.

Drug Abuse Equates With High Recidivism

The most common factor in recidivism rates among prison populations is drug abuse and drug-related offenses, and yet a recent report by the National Center on Addiction and Substance Abuse (CASA), indicated that as of 2010, though more than half of all prison populations met the diagnostic criteria for a substance use disorder, fewer than 11 percent received treatment for the addiction. A higher number took part in support groups or applied self-help materials. At the same time, prison populations continue to grow.

Programs that involve CBT have been shown to greatly reduce recidivism and moving forward, could be a key element in reducing overall prison populations within the United States. They are also key to reducing rates of violent crime like rape and murder, related to drug offenses.

Though the Bureau of Prisons does contract with treatment providers in all 50 states, access to these programs may be limited. Someone in prison who wishes to obtain CBT or participate in a residential addiction treatment program will need to make this request through their assigned caseworker. Twelve Step programs like Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) have also been powerful tools in battling addiction in the prison setting.

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