Substance Abuse in prisoners

The United States now incarcerates people at a rate nearly five times the world average primarily because of drug offenses. More than two-thirds of jail inmates were found to be dependent on or to abuse alcohol or drugs. Furthermore, half of all convicted jail inmates were under the influence of drugs or alcohol at the time of their offense.[31] Substance abuse and the enforcement of antidrug laws have fundamentally affected the growth of America’s prisons and jails over the past 20 years and the types of inmates they house. This rise corresponds to the focus on the War on Drugs now entering its 40th year in the United States. Enforcement of harsh drug laws has served to fill the prisons with minor players in this war (possession of small amounts of illegal substances) and has done little to abate the buying and selling of narcotics and other illegal substances.

In the United States, an overwhelming majority of state and federal inmates as well as jail inmates were either convicted of substance-related crimes such as drug selling or driving while intoxicated; were under the influence of drugs or alcohol at the time of their crime; committed a crime to get money to buy drugs; or had histories of regular illegal drug use or alcohol abuse.[32] More than 277,000 individuals, which accounts for 20 percent of state prisoners, and more than 60 percent of federal prisoners have been put in jail as a result of state and federal drug laws.

Statistics from the United States show that half of state and federal inmates were abusing or were dependent on drugs in the year before their incarceration. Nearly half of violent offenders in state prisons met the criteria for recent drug dependence or abuse and more than a quarter of these individuals committed their current offense while under the influence of drugs. Ten percent said that the need for money for drugs was a motive for their crimes.[33]

Women were more likely than men to have used drugs before their incarceration. In fact, some studies have shown that women appear to have greater problems with mental health and substance abuse than men.

One study identified that women in prisons used drugs more frequently and that they used harder drugs compared with male prisoners.[34] Acknowledging this situation, state and federal prisons have implemented drug treatment programs. Among drug-dependent or -abusing prisoners, almost half of state and federal inmates took part in drug abuse treatment programs since their admission to prison.

The prevalence of substance abuse and dependence, although highly variable, is typically many orders of magnitude higher in prisoners than the general population, particularly for women with drug problems. This highlights the need for screening for substance abuse and dependence at reception into prison, effective treatment while in custody, and follow-up on release. Specialist addiction services for prisoners have the potential to make a considerable impact.

The use of illegal drugs was recognized as a major category for health promotion among prisoners by the National Institute of Corrections in the USA in 1991 [35] and the WHO in 1999.[36] Clearly, a strong relationship exists between substance dependency and crime and mental health problems among prisoners.


Of the estimated 2.3 million inmates currently incarcerated in U.S. prisons, 1.9 million could benefit from alcohol and drug treatment, which could ultimately save taxpayers millions of dollars, according to a new report. Currently only 11% of inmates who need treatment are receiving it during their incarceration.

Approximately 85% of current inmates could benefit from treatment, according to The National Center on Addiction and Substance Abuse (CASA) at Columbia University.

The CASA report, “Behind Bars II: Substance Abuse and America’s Prison Population,” shows that 1.5 million of the estimated 2.3 million prison inmates meet the DSM IV medical criteria for substance abuse or addiction.

Another 458,000 inmates have a history of substance abuse and were either:

  • Were under the influence of alcohol or other drugs at the time of their crime.
  • Committed their offense to get money to buy drugs.
  • Were incarcerated for an alcohol or drug law violations.


Madelon L. Finkel, PhD
Madelon L. Finkel, PhD, is professor of clinical public health and director of the Office of Global Health Education at the Weill Cornell Medical College in New York City, NY. Dr Finkel is an epidemiologist whose work focuses on women’s health issues. Her interests also include global public health issues with ongoing research projects in rural India and Peru. Dr. Finkel has published extensively, including Praeger’s Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening and Truth, Lies, and Public Health: How We Are Affected When Science and Politics Collide.



  1. Walmsley R. World prison population list. 7th ed.
  2. Wikipedia. Prisoner population rate 2007-2008.
  3. Mauer M. Comparative international rates of incarceration: an examination of causes and trends: Presented to the US Commission on Civil Rights; June 20, 2003; Washington, DC.
  4. US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Correction statistics.
  5. Ibid.
  6. Federal Bureau of Investigation. FBI uniform crime report.
  7. Maruschak LM for US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Medical problems of prisoners.
  8. Griefinger RB, Heywood NJ, Glaser JB. Tuberculosis in prison: balancing justice and public health. J Law Med Ethics. 1993;21:332-341.
  9. World Health Organization. Tuberculosis in prisons.
  10. Shalit M, Lewin MR. Medical care of prisoners in the USA. Lancet. 2004;364:34-35.

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