Prisons: Problems and Prospects

The influx of drug-related offenders is a key source of prison overcrowding, and it makes life behind walls difficult for inmates and the staff. Incarceration rates for murderers, robbers, and burglars have remained steady over the years, but the number of drug offenders who have been imprisoned has steadily escalated. At present, six of ten federal prisoners stand convicted of drug possession or drug use, and the federal prison system is operating at 19 percent over its capacity. State prisons are also overcrowded, though the proportion of drug offenders is not quite as high.

Since the early 1980s, prisons have increasingly become repositories of nonviolent felons, many of whom are addicted substance abusers. Such offenders pose limited risk to the community, and arguably are not the type of hard-core criminals for which prisons were invented or designed. Most nonviolent prisoners could benefit from serious supervised treatment programs that address their substance abuse problems. Such treatment is available in many prisons, but it would be much less expensive to treat the addicts without locking them up. Arizona diverts all its addicted offenders from prisons to probation, in line with the results of a referendum provision called the Drug Medicalization, Prevention and Control Act, which Arizona voters approved by a 65 to 35 percent margin. An appeals court judge has pointed out that compared to the typical Arizona offender who now gets probation and treatment, "the same guy in the Federal system is going to get a mandatory five-year sentence" (Wren, 1999). The difference in deprivation is appreciable, as is the burden to the system.

While Arizona is the only state that has implemented a policy of wholesale diversion, other states have experimented with drug courts, which steer addicts into community treatment. Several prison systems are also accelerating the release of their nonviolent offenders. The most popular strategy for early release involves the use of shock incarceration, which provides a short, intensive experience of treatment, education, physical exercise, and military discipline.

The war on drugs has generally contributed to prison congestion across the board, but it has particularly increased the proportion of women and minority offenders who are sent to prison. At the onset of the war on drugs, in the early 1980s, 4 percent of the prison population was female, but the proportion by mid-1998 was 6.4 percent and increasing. Women constitute over 10 percent of the U.S. jail population, and drug addicts make up the majority of the women who are jailed or sentenced to prison.

The proportion of minority prisoners has also escalated sharply as a result of the war on drugs. The Bureau of Justice Statistics has calculated that 82 percent of the prisoner increase in the federal system between 1990 and 1996 involved black offenders sentenced for drug offenses (the same held for 65% of whites). In state prisons, 30 percent of the increase among black prisoners was due to drug sentences, compared to 16 percent among white prisoners. These differences derive from the fact that street enforcement of drug laws has centered on open trafficking in the ghetto, and the majority of those arrested for drug trading are addicts who are supporting their own drug habits.

Differential effects of the war on drugs create differential problems in prisons beyond those that are immediately obvious. In the case of women, one such problem is that of family separation, since 75 percent of female prisoners are mothers. Small children of prisoners who are not cared for by family members frequently end up in foster care; mothers also lose contact with children where distance or other considerations make visitations difficult. Prisons for women try to mitigate such problems, but cannot do much beyond encouraging family visits. A few prisons provide nurseries for pregnant inmates to facilitate bonding of mothers and infants; many prisons offer courses in childcare and parenting, or sponsor support groups for mothers.

The influx of drug offenders has increased the demand for illicit drugs in prison despite the fact that drug use by inmates invites extended periods of solitary confinement. Given the nature of addiction as a compulsive or obsessive psychological disorder, considerable ingenuity is exercised by addicts to smuggle drugs into the prisons. Drugs arrive in prison visiting rooms in the face of systematic searches (including skin and cavity searches), close and continuous surveillance, and mandatory random drug testing. Short of strip-searching all prison visitors and totally prohibiting all contact visitation, there is no way of making a dent in this problem. No strategy can prevent the importation of drugs into settings that are inhabited by addicts who have supportive subcultural peer groups outside the walls.

A different consequence of the proliferation of addicted prisoners is the rate of infection with the human immunodeficiency virus (HIV) in the prisons. As of 1995, 2.4 percent of state prisoners were known to be HIV positive; the proportion reached 13.9 percent in New York state, where the war on drugs has been assiduously waged. The rate for women is higher than that for men, and African American inmates are disproportionately affected. But not all of the HIV infected prisoners are known to authorities, because HIV testing in most prisons is optional and the course of the disease is frequently asymptomatic. Many inmates do not know they are infected, and they can unwittingly infect other inmates—mostly by sharing needles, and sometimes through sexual contacts.

Active AIDS (acquired immunodeficiency syndrome) cases among prisoners call for expensive medical treatment, the costs of which are transferred from the community to the correctional system while the offenders are in prison. To their credit, prison physicians routinely prescribe costly drug combinations ("cocktails") that have sharply reduced fatalities among imprisoned AIDS patients. Between 1995 and 1996, AIDS–related deaths in state prisons decreased by 10 percent (from 1,010 to 907).

Female offenders incarcerated during the war on drugs have been disproportionate clients of medical services. Ross and Lawrence point out, for example, that "including the unique reproductive health problems of women, 28 percent of women admitted to state prison in New York in 1993 had medical problems requiring immediate and ongoing intervention" (p. 177). They noted that the illnesses of substanceabusing women "most often include asthma; diabetes; HIV/AIDS; tuberculosis; hypertension; unintended, interrupted, or lost pregnancy; dysmenorrhea; chlamydia infection; papillomavirus (HPV) infection; herpes simplex II infection; cystic and myomatic conditions; chronic pelvic inflammatory disease; anxiety neurosis; and depression" (p. 181).

Women prisoners need substantial care—including mental health services—but the dispensation of mood-modulating drugs is a controversial problem for women's prisons. Some critics of the system contend that medication is insufficiently available, while others charge that the inmates are overmedicated to control or restrain their behavior. Among women who live in prison, medical care is a common source of complaints, even where facilities appear to be adequate. One reason for the emphasis on physical complaints may be the monotony and boredom of prison life; another may have to do with addiction to prescription drugs.