Alcohol and Crime: Treatment and Rehabilitation

There are three contemporary justifications for the offering of treatment to persons with alcohol problems, all of which contrast to an earlier social welfare justification wherein treatment was offered because it was the morally correct choice. In the first of the contemporary justifications, the offering of treatment is essentially compelled by acceptance of the notion that alcohol problems are intermingled with alcohol dependency, and alcohol dependency is a medical or health problem. Sick persons deserve treatment and persons with alcohol dependency are sick persons.

The second justification is centered on social investment. This idea centers on the occupancy of significant social roles by persons with alcohol problems. Role occupancy in turn indicates that others are dependent upon the focal individual, allowing that in some circumstances this dependence may be symbolic and obligatory, such as the deference that is offered to the needs of elderly family members even though their "productivity" may be strictly symbolic at present but historically significant. Thus treatment is offered through allocating the resources owned by different interest groups, typically families or employers.

The third justification is focused on recidivism. Criminals with alcohol problems are seen as double deviants in a sense different from that used here, namely that there is a causal interdependence between their substance use and their criminality. While it is widely asserted that drinking facilitates crime, the element of differential association with bad company that accompanies drinking and illegal drug use is a secondary facilitating factor. Thus some data indicate that successful treatment of criminals' substance abuse problems will have a desirous effect on recidivism (Pearson and Lipton).

How are criminals linked to these justifications? Looking first at the illness-entitlement idea, it may be difficult to view criminals with alcohol problems as "sick." By definition, they have already received a cardinal label of criminality that implies "bad," not sick. "Bad" is the marker for imputing responsibility for deviant behavior, and the administration of the label "criminal" immediately excludes the possibility of an illness label. Thus, with the "sick" label absolving responsibility and the "bad" label imputing responsibility, "sick" and "bad" have a very difficult coexistence as labels for the same individual.

Thus the administration of criminal labels creates a logic-based resistance to the placement of a sick label on a criminal with alcohol problems. This is not to say, however, that the criminal justice system denies that alcohol problems exist among criminals. Instead, the alcohol problem is seen as something that may interfere with an individual's eventual return to society, as well as a possible contributor to recidivism, but it is clearly not the individual's cardinal problem, which is his or her criminality. There may be no reluctance in agreeing that a criminal's alcohol problem is secondary, or even lower in priority, but there cannot be the administration of a cardinal label wherein the criminal is seen as sick and thus deserving treatment.

Turning to the social investment justification, it is important to examine the role occupancy of the criminal. By being placed in prison, he or she occupies the prisoner role, and may be part of different social networks within the prison. Occupancy of social roles outside the prison is nonexistent or, at best, suspended. It is very rare for employers to hold open job positions for individuals while awaiting the completion of their incarceration. While fathers and mothers, as well as husbands and wives, may be deeply missed by their significant others during their incarceration, the demands of these vacant roles must be filled by others or not filled at all for the duration. Thus the social investment justification for providing treatment for alcohol problems is largely missing.

As mentioned, a principal goal of most prisons is the reduction of recidivism. Recidivism can also be understood in the terms of social roles. An individual who is a recidivist must return to a previous role in the community involving criminal behavior, or adopt a new criminal role configuration, for without such role occupancy, there can be no repeat offenses. Because roles in families and employment become "closed out" for individuals who are incarcerated (assuming they occupied such roles prior to incarceration), their opportunities following the completion of incarceration may be limited to prior roles involving engagement in criminal behavior. Indeed, this possibility may be enhanced if they were evaluated as particularly valuable in the performance of criminal acts by criminal peers, and these persons welcome them back into roles that may have been "held open" for them.

Given these facts, it is only logical to conclude that the major justification for the offering of treatment to criminals with alcohol problems is the traditional social welfare concept that it is the right thing to do. If this is correct, then it immediately explains why the offering of treatment for alcohol problems to criminals drifts down the list of priorities of what can be effectively carried out in the prison environment. The possibility of allocating resources for the treatment of alcohol problems essentially "competes" with other morally compelling programs, such as addressing criminals' mental health problems, dealing with their physical health, and providing them with skills so that they are attracted to noncriminal work opportunities when their incarceration is completed.

The published literature on the effectiveness of treatment invariably supports three general conclusions. First, that there are not enough available resources to afford the widespread availability of such treatment (Wright); second, that the extent of success in treatment is closely linked with the amount of time that criminals are retained in treatment programs (Farabee et al.); and third, that the long-term impact of this treatment on both recidivism and recovery from alcoholism is contingent on a vast range of factors that are extremely difficult to capture with available evaluation technology (Kinlock et al.; Hiller et al.).

Thus, it might be expected that investment in alcohol problem treatment for criminals would be found in an environment of munificent resources where a range of criminals' problems in living in the world were addressed. This would of course assume that the allocation of resources to alcohol problem treatment effectively competed with the demands and lobbying of other constituencies invested in morally compelling programs.