Tag Archives: alternatives to incarceration

Substance Abuse and Social Capital

While the Donald Trump / Jeff Sessions administration is working to re-invigorate the war on drug users, a number of new studies look at relationships between social / cultural / economic capital on the one hand, and drug use, on the other. In my own research with criminalized women in the Boston area I witness the drug-encouraging perfect storm of poverty, marginalization, and the absence of meaningful opportunities for understanding how social inequalities cause suffering.

Despite popular articles (including this one in the New York Times) extolling drug treatment in prisons, newly emerging research suggests that locking up drug users is just about the worst thing we can do if we want to reduce drug-related deaths. By removing people from sources of social and cultural capital, we are exacerbating the very conditions that lead far too many Americans to abuse substances to begin with.

Opiate deaths in a former manufacturing community

A recently published qualitative study looks at factors contributing to drug overdose in the Monongahela Valley of Pennsylvania. This is a region that used to be a center of steel production but is now economically very depressed as manufacturing has shifted out of the area. The author interviewed people at a drug treatment program and found that they mostly spoke about lack of jobs and overall hopelessness in the local communities. The author concludes, “While state and county efforts to ameliorate overdose mortality have focused upon creating an open market in naloxone, this study suggests the need for interventions that address the poverty and social isolation of opiate users in the post-industrial periphery.”

To me, it’s interesting that the author makes the connection between poverty and social isolation for the “post-industrial periphery” but I think the same argument can be made for urban and suburban areas.  When people feel isolated and hopeless — and, of course, when mood altering substances are easily available — drug use can be quite attractive.

I suppose that the appeal of 12 step groups such as Alcoholics Anonymous and Narcotics Anonymous lies both in the sense of community (though, of course, it’s a constructed community that one loses as soon as one “relapses”) and the hope relayed by the success stories recited at meetings. Unfortunately, however, the hope and success (which is not as common as 12 step proponents like to claim) are limited to the specific context of the meetings. Commitment to sobriety does not change the economic reality of dead-end jobs, companies that do not have loyalty to employees, wages that don’t allow people to save money towards things like home ownership that truly bring hope, and so on.

Social capital and drug overdoses: a quantitative analysis

Another new study makes a similar point. In “Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States” the authors used large-scale county-level data. The data show a pretty clear correlation between low social capital and high overdose death rates. The authors measured social capital in terms of the density of civic organizations, the percentage of adults who voted in elections, response rate to the census, and the number of non-profit organizations in the county.

While these measures are not perfect (in my opinion) they are suggestive. I’m particularly interested in the correlation between voting and drug overdose rates. In my own work I see a connection between substance abuse and the sense that one is stuck in world over which one has no power to make things better. Not just hopelessness but also powerlessness seem to drive at least some of the excessive drug use that we are witnessing around the country. In fact, according to the Sentencing Project, “one of every thirteen African Americans has lost their voting rights due to felony disenfranchisement.” Moreover, “A record 6.1 million Americans are forbidden to vote because of … laws restricting voting rights for those convicted of felony-level crimes. The number of disenfranchised individuals has increased dramatically along with the rise in criminal justice populations in recent decades, rising from an estimated 1.17 million in 1976 to 6.1 million today.”

What this study cannot get at is the variability of access to social capital within particular counties. I sometimes hear the women I have come to know speak with deep sadness about how other people seem to get the breaks while they just can’t catch a break. These women are likely to see their misfortunes as an individual failure or bad karma, but when I look at their life experiences I often see how identifiable policies forced them to be cut off from sources of social capital. Locked into jails, homeless shelters, rehab programs, low income housing and temporary jobs (at best), they are systematically excluded from the primary sources of social capital in our communities.

The women I know tell me that they want to help others, but even volunteer positions require criminal background checks. Many want to be part of church communities, but they find that churches drop them like hot potatoes when it becomes clear that they need more help than the congregations want to provide to any one individual.

Creating social and cultural capital: A revolutionary program in San Francisco

I’ll close here with a third article I read this week. This one highlights a program that addresses social and cultural capital in a very profound way. “Making the case for innovative reentry employment programs: previously incarcerated women as birth doulas – a case study,” documents a San Francisco program in which formerly incarcerated and low-income women were trained as birth doulas. 

According to the authors, “Realigning women within communities via birth support to other women also provides culturally relevant and appropriate members of the healthcare team for traditionally vulnerable populations. Doulas are important members of the healthcare workforce and can improve birth outcomes. Our work testing doula training, as a reentry vocational program has been successful in producing 16 culturally relevant and appropriate doulas of color that experienced no re-arrests and to date no program participant has experienced recidivism.”

Of course, not everyone is suited to be a doula! But the lesson from this project is far broader. Through participation in the program the women joined an on-going community, learned that they can be powerful agents in helping other women take control of their own births, and they not only acquire but also create meaningful social and cultural capital.

 

Alternatives to Incarceration: Be Careful What You Wish For

As awareness is growing of the financial and human costs associated with mass incarceration, we’re hearing talk from politicians on both sides of the aisle (and, believe it or not, even from the Koch Brothers) about the need for “alternatives to incarceration” (ATIs).

The term “alternatives to incarceration” takes for granted that we are talking about ways to handle criminals who otherwise would need to be incarcerated — that incarceration is a reasonable baseline against which to measure “alternatives.” In light of the over-representation of Americans of color and low-income Americans in jails and prisons, however, it’s necessary to be careful about any sort of presumption of correlation between criminality and incarceration. In fact, about a third of people locked up in the US are awaiting trial; that is, they have not been convicted of a crime. Another third are locked up because they violated the terms of probation or parole; that is; the “criminal” act was not sufficiently egregious to require imprisonment but a subsequent action – often simply not showing up for a meeting with a parole or probation officer, or failing to keep up restitution payments or money owed in court fees – was the reason for incarceration. And 97% of federal and state criminal prosecutions are resolved by plea bargain – often accepted by defendants out of fear that if they don’t accept the deal they will be locked up even longer — rather than by trial.

Given these numbers, it’s easier to make a case for abolition than for “alternatives to incarceration.” But that is not the direction in which public discourse seems to be moving. To the contrary, the increasingly popular sentiment goes something like this: A whole lot of people sitting in jails and prisons are mentally ill; they are drug users who need treatment more than they need punishment. Echoing this sentiment, Los Angeles County – the US county with the largest number of incarcerated people – recently approved a $1.9 billion proposal to tear down Men’s Central Jail and construct a 4,885-bed “Consolidated Correctional Treatment Facility”. And while “treatment” certainly sounds beneficial, the content of that treatment has yet to be spelled out.

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Over the past five years I followed a cohort of Massachusetts women who cycle in and out of prison as well as a variety of treatment programs. All of the women, at some point in their lives, have been diagnosed with a psychiatric disorder (most commonly substance abuse, bipolar disorder, PTSD). Overall, these twenty-six women spent far more time in treatment than in correctional settings. Yet, at the end of five years only three women had settled into reasonably secure housing, stable employment and long-term desistance from substance abuse.

Typically, treatment programs include some combination of pharmaceutical, twelve-step and psychotherapeutic components. Most of the women I have come to know are prescribed mind-boggling assortments of psychotropic medication, some of which make them, as Elizabeth (a white woman in her early forties, Elizabeth was homeless for a decade) used to say, into “a space shot” who shuffles around in a daze that puts her at elevated risk for being robbed or assaulted. Whether anti-anxiety, anti-depression or anti-psychotic drugs, these medications are not intended to cure the underlying problems such as sexual assault and homelessness that lead to anxiety, depression and substance abuse. Rather, psychotropic medications are prescribed in order to manage the individual’s response those problems.

While not all treatment programs prescribe psychotropic medication, virtually all incorporate – explicitly or implicitly — twelve step ideology and practices. Treatment facilities tend to be plastered with twelve step slogans such as “Let Go and Let God” and “Cultivate an attitude of gratitude,” and formal AA/NA meetings typically are part of the treatment regime. With emphasis on admitting one’s powerlessness (Step 1) and making moral inventories of one’s faults (Step 4), these programs do not seem to offer the women I have come to know a meaningful script for re-organizing their lives. When I visited Joy, who has been homeless for nearly fifteen years and nearly died as a consequence of a brutal sexual assault, several weeks into her stay in a treatment facility she enthusiastically explained to me that, “I’m learning that my problems are in my head.” Unfortunately, her problems also were in the real world: Less than a year later she was back on the streets where she was sexually accosted by a police officer who then arrested her for solicitation.

Most treatment programs in Massachusetts also include some sort of psychotherapy, and nearly all of the women I know have been treated by multiple therapists over the years, sometimes beginning in adolescence or even childhood. With its focus on the individual psyche, psychotherapy addresses personal flaws such as poor impulse control, allowing oneself to be a victim, and struggles to “get over” past traumas. But as Elizabeth explains, “I don’t need to talk about my problems. I need a place to live so that I won’t be scared all of the time.” This does not mean that therapy is useless; it does mean that “talk is cheap” without the material conditions that permit women like Elizabeth and Joy to build a secure life.

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There is little evidence pointing to long-term success for any particular drug treatment modality. Studies showing positive outcomes typically fail to track program participants for long enough time to establish meaningful rates of success, look only at participants who completed the program, fail to control for confounding variables, or look at very small numbers of participants from the start. The absence of evidence for the success of treatment programs is especially glaring when the treatment is coerced or carried out in a coercive situation. It may be tempting to believe that even if treatment doesn’t help everyone, at least it doesn’t hurt. Yet, as we’ve learned from the past — from efforts to “cure” homosexuality to the tranquilizers (“mother’s little helper“) of the 1960s,  when a patient’s ideas or behaviors challenge social hierarchies of race, gender, sexual orientation or class, treatment that is ostensibly for the patient’s own good may be used to bring the “deviant” individual back into line. As those of us old enough to remember Jack Nicholson’s performance in One Flew Over the Cuckoo’s Nest can attest, therapeutic interventions aimed at “getting inside” the patient’s head can carry heavy costs indeed.

The murky line between punishment and treatment has not been lost on some of the corporations involved in the prison industry. Correctional Healthcare Companies, for example, has expanded beyond providing medical services to prisons and now offers services for the “full spectrum” of “offenders” lives: “pre-custody, in custody, and post-custody,” a timeline that perhaps says more than the company intended about American understandings of criminality.

Read more: Incarceration by Any Other Name: A Return to the Cuckoo’s Nest?

Video: Alternatives to Incarceration

As awareness is growing of the costs (both financial and human) of mass incarceration, we’re hearing more about alternatives to incarceration. These alternatives include various sorts of electronic monitoring, intensive supervision, drug courts and mandated drug treatment.

While I am in favor of almost any plan that keeps non-violent people out of jails and prisons, I think it’s important to take a critical look at what is meant by “alternatives to incarceration” and how these actually play out given the broader contexts of dominant American ideas concerning crime, justice, gender and race. Do ATI really challenge the assumptions regarding who is ‘guilty’ and what it means to be ‘fixed’? Without fundamental changes in how we view human rights and relationships, ATI can too easily become a way to broaden the net of people caught in the correctional system.

This video clip by Meredith Berg includes some of my thoughts as well as comments by two proponents of ATI, one who works with a small not-for-proft organization and one who works in the correctional system.

https://www.youtube.com/watch?v=JzRZhJ1uKXs

You can read more about the thin line between ‘punishing’ and ‘treating’ here:
Incarceration by Any Other Name: A Return to the Cuckoo’s Nest?