Before Kidd became a legal adult, he had already experienced racism, the foster care system, abandonment and the suicide of a parent. He began selling drugs as a teenager to make ends meet and find belonging, and became a father before he had an opportunity to grow up himself. As a young adult, when the doors of an adult prison slammed behind Kidd for the first time, he was already deeply familiar with the justice system. His childhood trauma didn’t leave him as he stepped into adulthood, but was compounded by incarceration. When his daughter passed away while he was serving his sentence, Kidd turned to substance use to cope with his grief. In his words, “I feel like the death of my daughter and brother has forced me to grow up… This last year has been the hardest of my incarceration and perhaps my life.”¹
When an incarcerated person enters prison for the first time, they are usually not a stranger to intense challenges like Kidd’s. Research shows that over 90% of adults in prison have been exposed to traumatic events, often at a very young age. These early adverse experiences lead to an increased risk for addiction and mental health conditions — often conditions that are untreated by the time they enter the correctional system.
This article provides a snapshot of the need for substance use and mental health treatment programming in prison settings, while also describing the uphill challenges prison staff face in addressing these challenges effectively. Finally, solutions are offered to begin addressing the gap between programming need and correctional agencies’ ability to deliver.
Substance use among prison-based populations
Dee turned to drugs to numb the trauma of his childhood and his own criminal behavior. In his words, “My soul felt as if it ached all of the time, so I increased my dope intake to numb the sensation.” Dee was sent to prison for murder while he was still a minor.¹
While 8% of the U.S. population is experiencing addiction, nearly half of U.S. inmates have been diagnosed with a substance use disorder. And substance use doesn’t end when people enter the system; a 2019 report showed that 7% of all prison deaths were due to drug or alcohol intoxication.
Mental health conditions among prison-based populations
All the Violence Pain and Misery,
Created the monster that dwells inside me…
No one Cared, no one seems to understand,
How I became a gangster, a Violent and Vicious man…
Maybe it’s because my mother and father abandoned me,
Turned me into a str8 Menace to Society…
No one honestly knows the Nightmares I’ve lived,
For the hurt, pain, sorry I’ve hid…
— Mark, “The Monster Inside of Me”
Mark, who says he’s been incarcerated all his life, found an outlet for his “innermost deep feelings” through poetry. He says, “I’ve been able to discuss my angers, fears, pain, and happiness through my writings. I’ve had so much trauma throughout my life. I learned at an early age to vent and express myself through trauma.”²
While about 22% of adults in the general population are experiencing a mental health condition, nearly 40% of adults in prison have been diagnosed with a mental health condition; and a vast majority of these mental health problems can be attributed to childhood trauma.
Trauma and complex PTSD among prison-based populations
Sergeant’s earliest memory is of his mom and her boyfriend fighting. As he grew older, he struggled to find a balance between caring for his family and pursuing the opportunities of military service. As his family life and military-related PTSD came to a head, he remembers, “My little brother Joey began running the streets and hanging with a gang, and my brother Michael’s mind was messed up from growing up around so much violence. My family was all screwed up, and I wanted to be the one who stabilized it. But I realized I had some mental wounds I needed to deal with before I could do that.”¹
The prevalence of mental health and substance use conditions in prison populations can be attributed to another alarming statistic: that over 90% of adults in prison have been exposed to trauma.
These traumatic events range from violent assault, witnessing injury or death, losing loved ones to homicide or overdose, or experiencing serious health incidents themselves. What’s more, over half of adults in prison have been subject to abuse and neglect for extended periods of time, resulting in complex trauma and PTSD.
Treatment programming within the prison system
Despite the prevalence of substance use disorder, mental health conditions and trauma among prison populations, accessing treatment can be a challenge. On average, 1 in 10 people with a substance use disorder receive treatment in prison, and 4 in 10 receive mental health treatment. Similarly, risk-need-responsive programming for things like anger management, emotional self-regulation, reentry preparation, relationship-building skills and job readiness are often in high demand, leading to long waitlists and missed opportunities for some incarcerated adults prior to release.
This does not mean that passionate staff and concerned state agencies are not making real efforts to address the programming gap in correctional systems. The unfortunate reality is that despite strong recruitment and retention efforts on the part of many departments of corrections, state prisons have lost nearly 65,000 workers since the COVID-19 pandemic, and that number continues to rise. In short-staffed prisons, safety and security must become the number one priority, meaning fewer opportunities for education, treatment programming, vocational training, recreation and other programs.
The loss in benefits when programming needs aren’t addressed is significant. Substance use treatment programming could decrease the well-known risk of overdose within two weeks following prison release for individuals with opioid use disorder. Importantly, it could also increase resistance to substances within the prison, since illicit drugs do make their way into facilities despite valiant efforts of staff.
One study showed that violence and disciplinary procedures were top reasons for lawsuits by adults in custody. Prosocial programs could not only increase safety and reduce behavioral incidents, but save money for agencies in the long term. For taxpaying stakeholders, rehabilitative programming does more than reduce recidivism — a common metric for success — but also helps incarcerated individuals become more productive, contributing members of society, creating healthier communities and positive generational ripple effects.
Solutions from the inside
Strategies for streamlining essential programming in prisons while understaffed and resource-constrained include:
- Allowing peers with good track records and longer sentences to receive training to facilitate programs.
- Leaning on self-directed programming to support participants on long waitlists.
- Utilizing tablets for more than just games and communication, and including evidence-based platforms like Atlas to provide risk-need-responsive programming content.
- Allowing self-help groups, like Alcoholics or Narcotics Anonymous, to run in your facility.
- Increasing opportunities for family visits, since family support is one of the most important factors for successful reentry.
- Creating trauma-informed environments through careful staff training and units designed to rehabilitate as much as promote safety.
- Contracting with outside agencies to provide mental health and substance use treatment, including through telehealth streaming for remote or rural prison facilities.
- Like Mark, many incarcerated individuals find an outlet for self-expression through the arts. Allowing outlets for artistic expression through approved mural work, galleries, poetry recitations, publications, or workshops run by outside volunteer groups can provide much-needed outlets for creativity.
The next blog in this series will delve more deeply into these programming strategies.
¹This story is taken from the book Imprisoned Minds: Lost Boys, Trapped Men, and Solutions from Within the Prison by Erik S. Maloney and Kevin A. Wright. This anthology of first-person narratives illustrates the childhood trauma and neglect that lead many individuals to incarceration.
²This excerpt comes from the publication Legacy: A People-first Magazine; the result of a collaboration between Arizona State University students and incarcerated individuals.
Providing risk-need-responsive programming content
While a range of digital tools exist to support correctional staff, Atlas is the only digital resource that provides a comprehensive library of engaging risk-need-responsive content — including a multimedia library and Interactive Journals — delivered in a HIPAA-compliant, mobile-first environment.
To learn more about Atlas and how it supports justice agencies like yours, download the Justice Services Atlas overview here.