The national impact of substance misuse
More than a year into the pandemic, overdose deaths in the U.S. skyrocketed to a record 100,306, a nearly 30% increase over the year prior at 78,056, according to provisional data from the Centers for Disease Control and Prevention (CDC). While this increase is horrifically high, it is not surprising. Covid-19 has created economic insecurity, anxiety, and the disruption of every aspect of life; this has resulted in tremendous stress and challenges to our mental and physical health which has led more Americans to turn to substances to cope than ever before. Those already with a substance use disorder (SUD) found treatment harder than ever to get. Mental health declined at a rate never seen before.
These shocking statistics serve as a stark reminder that there is a tremendous need to address and tackle SUDs in a meaningful way.
Incarcerated individuals and the front-line responders who work within the jail and prison system are some of the most impacted when it comes to stress, depression, grief, substance misuse, and suicide.
According to The National Institute of Health, 85% of individuals suffer from SUD while incarcerated due to trauma exposure or issues existing before their incarceration. The environment within jails and prisons can worsen the problem due to lack of sleep, compassion fatigue, mental and physical health care gaps, and stigma. Confidential and virtual care that individuals can access anywhere is one very important solution to reducing recidivism and other effects of substance misuse in facilities. It’s also very important to take a real look at the causes of recidivism in corrections and the subsequent cost implications.
Recidivism rates among incarcerated and newly released individuals are high, with drug overdose deaths 129 times more likely within two weeks after being released from jails and prisons. Additional staggering statistics include:
- 80% of inmates report abusing substances in their lifetime (Addiction Science)
- 53% of people in jail meet the DSM-IV criteria for substance abuse disorder (Addiction Science)
- 90% of suicides are carried out by someone with depression, struggling with substance misuse, or a combination of both (Addiction Center)
Causes that contribute to recidivism in corrections and subsequent costs
There are various reasons that individuals return to drug use post-release from jail or prison. Causes include poor social support, medical problems, and inadequate financial resources to support integration into the community. Furthermore, they experienced ubiquitous exposure to drugs in the neighborhoods to which they were released. Intentional overdose is often identified and leveraged as “a way out”. Other important considerations in identifying causes of recidivism include:
Continuity of Healthcare: Data from the Bureau of Justice Statistics found that more than half of individuals leaving correctional facilities have at least one chronic health condition, be it mental or physical.
Community Resources: Local and national policies ban recently released individuals from accessing federally funded programs and food stamps. Individuals remain ineligible even after completing their sentence or overcoming substance abuse. Denial of these crucial services makes it difficult to re-enter society and fully support themselves.
Un-Treated Addiction: The National Center of Addiction and Substance Abuse at Columbia University estimates that of all incarcerated individuals with substance abuse issues, only 11 percent of those that need treatment actually receive it while incarcerated.
Employment Instability: The stigma of a criminal record, limited education, and incarceration significantly increase the obstacles to gaining meaningful employment. Some states also allow employers to deny employment to previously arrested individuals, even if they were never convicted.
A successful strategy in place can reduce recidivism rates and health care costs
Former inmates identified factors that prevented relapse and overdose, including structured drug-treatment programs, spirituality/religion, and family. These results point to several considerations for the design and implementation of interventions in the immediate post-release period.
Programs need to be evaluated that will help public and private penitentiaries reduce substance misuse during incarceration and re-entry into society through its after-care services.
When it comes to how most conversations go surrounding the best treatment options for substance use disorders
(SUD), a lot of time is spent debating between Medication Assisted Treatment and Abstinence Based approaches, among others. While both of those (and several others) are highly effective, there are bigger issues that need to be addressed first.
We already mentioned the record-breaking number of overdoses last year. Another concern is that 90 percent of individuals that struggle with SUD don’t seek recovery for three general reasons: fear, stigma, and not wanting to admit that they’re an addict (Addiction Center). It’s time to start evaluating programs that don’t require those struggling to admit they have a problem. It’s more productive and successful for the individual to start thinking about the kind of future they want and the steps they will need to take to help you get there.
When someone that’s struggling with SUD hears the word “recovery” they automatically assume that means they need to go to rehab, but that’s not necessarily true. 46% of people reported that they were able to reach remission of substance use disorder on their own. Even though that’s a promising number, keep in mind that the more severe the substance use disorder, the more likely the individual will need professional support.
Research has shown that if people engage in treatment AND recovery, they will get better. Staying engaged with your recovery and/or treatment plan is crucial, though. According to the Journal of Drug and Alcohol Dependence, abstinence-based OUD programs see a whopping 85% dropout rate.
It’s worth clarifying that substance use disorder isn’t simply a “bad habit” or “bad behavior”. It truly is a neurological condition that won’t just go away on its own. Over time, it becomes uncontrollable and irrational; something the individual becomes dependent on. Substance use disorder and addiction affect nearly half of all Americans, either directly or indirectly. 46% of Americans either struggle themselves or have a close friend or family member that struggles with SUD (SAMHSA). 18% of workers also go home to addiction every single day (Gallup).
It’s important to focus and consider programs that address:
- Why the 90 percent of individuals who struggle with SUD don’t seek help
- Current addiction treatment systems and practices and how engagement specialists fit into that continuum of care.
- The technological advances that supplement existing care within the context of current treatment practices.
It’s also critical to consider how a person’s family fits into their recovery journey. Because a person’s family is directly and profoundly impacted by their substance use disorder, loved ones should be involved in the recovery process. The only reason to exclude them is if it would prove detrimental or dangerous for the person needing recovery or for any of the family members.
It’s important to note that family recovery should not be approached with a “one-size-fits-all” kind of mindset. Each family and their circumstances are unique and what works for one group of people won’t necessarily be the best approach for another group. Another thing to keep in mind is that even if their loved one disengages from their recovery journey, help should still be accessible to family members, especially since they are five times more likely to be admitted into the hospital than the general population (NCBI).
The impact of stress on those working within the jail/prison system
First responders already face a challenging task in the line of duty. Whether they are working as a law enforcement officer, firefighter, EMS, or in corrections, they are all susceptible to high levels of stress and trauma compared to the public. Depression and PTSD are up to five times more common in first responders, resulting in higher levels of substance misuse to help cope with the symptoms and feelings.
A recent report from SAMHSA revealed that first responders, including those working the front line within jails and prisons similar behavioral health effects from the hazardous situations they face every day. The time between traumatic events is often minimal, going from one high-stress situation to another resulting in compounding grief. The most significant behavioral and mental challenges that overlap all three branches of first responders are:
- Post-Traumatic Stress Disorder and Symptoms
- Suicide/Suicidal Ideation
First responders are three times more likely to suffer substance use disorders (SUD) than the general public, creating an impact on their co-workers and families. In addition, the effect of SUDs reduces productivity and motivation in the workplace, leaving their coworkers to pick up additional work to keep operations running smoothly, adding to their already challenging workload.
Individuals struggling with substance misuse and mental health often do not know where or when they will seek help, leaving 90% of those going without critical care. First responders need to be met where they are in the recovery process and by offering the right support from someone who has similar lived experiences.
First responders put themselves at risk to save and protect the lives of others, but rarely do ordinary people realize the extent of stress that they must endure. That is why programs that provide confidential access to help with support from people with lived experience as first responders must be available to first responders and their families.
About Rich Jones
Chief Clinical Officer Rich Jones, MA, MBA, LCAS, SAP, EVP, has more than 20 years in the behavioral health space, including mental health, Substance Use Disorders (SUDs), co-occurring disorders, and intellectual disabilities. Rich is a sought-after speaker and writer because he is passionate, authentic, and knowledgeable — listen to his podcast, You Learn You Turn.
About Youturn Health
Youturn Health is a virtual support program designed to help individuals and their family members struggling with stress, substance misuse, addiction, suicidal ideation, and grief utilizing evidence-based strategies. The core components of the comprehensive program include on-demand access to an online learning library, NAADAC-credentialed peer coaching, and care management where participants can quickly get support from trained healthcare professionals. Learn more at YouturnHealth.com.