Prison Reform, Substance Abuse and Mental Health

by Steve G. Parsons, Ph.D.

In the United States incarceration, substance abuse disorders and mental health disorders are inextricably intertwined.   It is simply not possible to effectively address crime (of any type) via incarceration alone, without also addressing substance abuse disorders and mental health. There are options to cut costs with respect to incarceration and therefore reduce inflation. 

Incarceration:  While U.S. incarceration rates have fallen for the last dozen years, we still incarcerate more people than any country on earth.  Our incarceration rate is higher than any other first or second world country (10 Countries With the Highest Incarceration Rates (usnews.com). The U.S. has more people incarcerated for drug-related crimes than those incarcerated for all crimes combined in all of western Europe. (41 Surprising War on Drugs Statistics [The 2024 Edition] (thehighcourt.co) In 2014, with 4.3% of the world’s population the U.S. had 25% of the world’s prisoners. Incarceration nation (apa.org)   The U.S. has a substantially higher incarceration rate than countries such as Russia, Venezuela, Iran, or Saudi Arabia (See, e.g., List of countries by incarceration rate - Wikipedia) The U.S. rate is 4.5 times that of China.  It is between approximately 10 and 15 times that of Iceland, India, Afghanistan, Norway and 25 other countries. 

The U.S. incarceration rate is now more than 4.3 times what it was approximately 50 years ago (Incarceration and Poverty in the United States - AAF (americanactionforum.org) Citing https://www.nap.edu/read/18613/chapter/4). Between 1990 and 1995 alone, Federal prison populations grew 53% (Mass Incarceration Trends – The Sentencing Project, citing Gillard, D. K. & Beck, A. J. (1996). Prison and jail inmates, 1995. Bureau of Justice Statistics.) Do we really believe that Americans are 10 or 15 times more likely to commit crimes than the citizens in India, Afghanistan or Iceland? Do we believe Americans today are more than four times “worse” than Americans 50 years ago?

“At least 79 million people in the United States have a criminal record” (Mass Incarceration Stats And Facts – Forbes Advisor). That’s nearly a quarter of our population with many million family members also affected. 

The Crime Rate Has Fallen over 30 years.  This high incarceration rate is not because crime has increased; in fact, crime rates have generally declined since they peaked in 1991. “Rather, the arrest rate—particularly for drug crimes—increased dramatically, while sentences have gotten longer.” Incarceration and Poverty in the United States - AAF (americanactionforum.org) 

The two graphs below are from the Federal Bureau of Investigation Crime Data Explorer CDE (cjis.gov) The first shows violent crime while the second shows property crime.  Violent crime rates were nearly twice as high in 1991 as they are currently.  The property crime rates in 1991 was approximately 2.5 times current rates.

The effect is even more pronounced if we focus on property crimes:

With these declines our current crime index value is about at the world average Crime Rate by Country 2024 (worldpopulationreview.com) 

The Costs of Incarceration.  In 2020 the direct cost of housing an inmate in most federal prisons was between about $36,000 and $39,000 per year Federal Register :: Annual Determination of Average Cost of Incarceration Fee (COIF).  Higher security prisons have higher costs and at the extreme, “it costs the American taxpayers an average of $900,000.00 per year per inmate to operate the Guantanamo Bay facility.” (What is the Average Cost to House Inmates in Prison - Encyclopedia.com)  Moreover, recidivism rates are high in the U.S., “an estimated 68% of released prisoners were arrested within 3 years.” (2018 Update on Prisoner Recidivism: A 9-Year Follow-up Period (2005-2014) | Bureau of Justice Statistics (ojp.gov))

Not only do we incarcerate more people than any other country, “no other country in the world pays as much to put people in prison as the United States …” (The Economic Costs of the U.S. Criminal Justice System - AAF (americanactionforum.org) Citing:  https://www.bjs.gov/index.cfm?ty=pbdetail&iid=6728) “The direct governmental cost of our corrections and criminal justice system was $295.6 billion in 2016, according to the Bureau of Justice Statistics.” (The Economic Costs of the U.S. Criminal Justice System - AAF (americanactionforum.org) Citing:  https://www.bjs.gov/index.cfm?ty=pbdetail&iid=6728)

The indirect costs of incarceration include the costs of the court system and the costs of families losing a wage earner and the public assistance monies paid to such families.  The rate of growth of incarceration of women is much higher than the growth rate for men and 58% of them have a child under the age of 18 (Incarcerated Women and Girls – The Sentencing Project)  Law enforcement resources are also diverted from other crimes to non-violent offenders and many officers are killed or injured in the line of duty.  Employers may lose an employee and children may lose a parent.  Family members are often devastated. There is also evidence that after incarceration former inmates have much higher rates of unemployment and lower wages (New data on formerly incarcerated people’s employment reveal labor market injustices | Prison Policy Initiative) “…lost earnings, adverse health effects, and the damage to the families of the incarcerated—bringing the total burden [direct plus indirect costs] of our criminal justice system to $1.2 trillion [in 2016].” (The Economic Costs of the U.S. Criminal Justice System - AAF (americanactionforum.org) 

Pre-Trial Incarceration. In the U.S., “of those in jail on any given day, more than 60% are there because they cannot afford the cash bail amount required for their release.” (Cash Bail Data: A Closer Look - The Bail Project). At any point in time “more than 400,000 people in the U.S. are currently being detained pretrial – in other words, they are awaiting trial and still legally innocent.” “The number of people in jail pretrial has nearly quadrupled since the 1980s.” (Pretrial Detention | Prison Policy Initiative). Often the government spends more money to incarcerate someone than the bail requirement they could not fund. There are efficient alternatives to unaffordable cash bail.

Substance Abuse and Incarceration.  Drug crimes represent 46 to 47% of federal prisoners (2019 Incarcerated Population by Type of Crime Committed - Felon Voting - ProCon.org See also, Incarceration and Poverty in the United States - AAF (americanactionforum.org). However, one study finds “85% of the prison population has an active substance use disorder or were incarcerated for a crime involving drugs or drug use.” (Criminal Justice DrugFacts | National Institute on Drug Abuse (NIDA) (nih.gov)

“Nationally, in 2018, law enforcement made more marijuana arrests than for all violent crimes combined.” Weed Arrests By State [These Numbers Will SHOCK You] (wayofleaf.com) “Across the U.S., law enforcement made more than 6.1 million marijuana-related arrests from 2010 to 2018. … Back in 2010, over half of all drug-related arrests in the United States were for marijuana, and 88% of all weed arrests were for possession.”( Weed Arrests By State [These Numbers Will SHOCK You] (wayofleaf.com)). In 2022 there were “227,108 arrests” [for marijuana-related charges]. “Of that number, 92% were for possession only.” (Weed Arrests Were Nearly A Quarter Million Last Year, Per FBI Data (forbes.com))

Incarceration v Interdiction v Treatment:  There are many studies that indicate that dollar-per-dollar, drug treatment is far more cost effective than incarceration or interdiction. Some studies indicate that dollar-per-dollar treatment is 10 to 20 times more effective than incarceration.  (See the References below).  Incarceration creates contact with real criminals and increases violence.  Incarceration takes workers out of the workforce and takes parents away from families. 

Conclusions.  It is nonsensical that the U.S. has an average crime rate similar to the world in total but our incarceration rate is much higher than the rest of the world.  For the U.S. with the highest number of prisoners comes the highest costs associated with incarceration; the direct and indirect costs of incarceration were $1.2 trillion in 2016.  Much of this cost is associated with incarceration for non-violent drug related crimes.  These are ones for which there is no victim (and if there were the “victim” did not file a police report).  Also, the current drug policy is the one preferred by drug dealers – that drugs remain illegal (or at least highly regulated).  After 50 years, it is time to admit that the old incarceration approach to the war on drugs has failed; lets change the policy from the one drug dealers want. 

First, we should, to the maximum extent possible, legalize drugs – this is consistent with the 9th amendment to the U.S. constitution that states that all of the rights of individual are not enumerated in the constitution.  Certainly, strict adherence to the 10th amendment indicates that drug laws, if they exist, should only exist at the state level.  The one exception is fentanyl, where the great majority of drug overdoses occur because the seller fraudulently represented fentanyl as another drug (such as cocaine, heroin, or meth).  Fraud is a real crime and fraud that leads to death is murder.

 Second, regardless of your position on whether drugs should be legalized, the fact is that incarceration is a very costly and ineffective way to deal with the drug problem.  Treatment is many times more effective – dollar per dollar than incarceration. 

Third, as with substance abuse disorders, the rate of mental health disorders is very high among the incarcerated population.  Without treating the mental health disorders of our incarcerated population, we are doomed to high rates of recidivism and repetition of violent crimes. 

America can’t afford to continue with the same strategy of the last 50 years - throwing money at jails and prisons.  Less costly and more effective options exist – it is time to embrace them.