Alcohol and drugs are implicated in an estimated 80% of offenses leading to incarceration in the United States. And approximately half of those who are incarcerated evidence symptoms of a substance use disorder. Substance users end up incarcerated for a variety of reasons– possession, violent committed while under the influence (of alcohol, in particular), selling drugs to fund a drug habit, or selling drugs as an enterprise. Many people in jails and prisons have serious co-occurring mental health disorders. Whatever the reason a person ends up in jail or prison, a substance use disorder should be treated as a health, not a criminal, issue.
Early release, probation, and parole systems typically mandate abstinence from drugs. It would seem logical, therefore, that abstinence from alcohol and other drugs would solve a whole host of problems and make transition into community life relatively easy. Yet people return to the homes and communities from which they came. They return to their families, their friends, and their livelihoods. “Just Say No” is easy to say, but not easy to do. Externally imposed mandates are negatively associated with motivation, and the injunction to “quit now and forever” has proven unrealistic. Many people have relationships with drugs that are too complicated for simple solutions. Many people have developed identities that are inextricably linked either with drugs, with criminal behavior, or with both. They need a complex treatment to meet their complex needs.
Harm Reduction emerged in the 1980’s as a public health response to the dangers of disease transmission and, later, to overdose risk among intravenous drug users. Harm Reduction Therapy (HRT) followed close on its heels. HRT is a new paradigm in the treatment of substance misuse. It offers an alternative to the disease model of addiction and abstinence-only treatment. Its chief characteristic is that it is radically client-centered and client-driven – it “starts where the client is” and moves at their pace of change, thereby effectively engaging people who avoid or are excluded from traditional abstinence-only treatments. It addresses the harms that arise from a person’s relationship with drugs and the identity dilemmas facing decarcerated individuals. Its goals are “any positive change” and its definition of “recovery” is “non-problematic use of substances.”
It would seem that, both in principle and in practice, HRT and its broad array of options for change are fundamentally at odds with the conditions of the criminal justice system. Not so. HRT is very pragmatic. It is able to navigate the conflict between external mandates and internal motivation by helping people comply with the conditions of early release at the same time as developing the internal motivation and skills to move toward self-determination, identity transformation, and a healthy relationship with drugs. The result of this sophisticated balance is that people are more likely to feel understood and respected, and they are more likely to engage in and stay in treatment. With its flexibility and sophisticated understanding of interlocking issues, it is an ideal treatment model for re-entering individuals.
We recommend, therefore, that the entire criminal justice system incorporate harm reduction as a way of understanding and working with the substance users and misusers under its supervision. In this way, everyone can be engaged in a transformative process that will promote transition out of the criminal justice system.