Photo by Susan Madden Lankford
Around the world an estimated 625,000 women and girls are deprived of liberty, by either awaiting or serving a sentence. In recent years, the population of women prisoners has increased at a faster rate than that of men. In Latin America, for instance, the female incarceration rate has risen from 40,000 in 2006 to 74,000 in 2010.
Traditionally women addicted to illicit drugs have been handled by the criminal justice system. However, over the past decade or so, there has been a slow but gradual recognition that imprisonment is not the most effective response to treating those with drug addiction, and as a consequence, a number of countries have been giving consideration to and/or implementing alternative options to imprisonment (more so in Europea) for addressing drug use and addiction problems. Reasons include overcrowded prisons, cost effectiveness, human rights issues and social and economic development issues. Failure to address the health and social issues related to drug addiction has major implications for public health and safety.
But most especially it has been increasing evidence, informed by research over the past decade, that drug addiction is a chronic medical disorder which can be successfully treated. And that treatment for drug dependence and addiction works best outside of prisons.
Not everyone realizes that drug addiction produces long-lasting brain changes which persist up to two years after discontinuing use. Craving is triggered by people, places and things associated with drug use, and withdrawal continues years after stopping drug use.
While drug use may begin as a matter of choice, once this has progressed to dependence or addiction, a barrier has been crossed and the problem becomes a medical condition, (contrary to the prevailing perception that drug addiction is simply a social lifestyle-related phenomenon over which the individual has control) requiring an integrated approach to its management.
Drug use/addiction triggers a number of severe adverse health consequences which are either fatal or chronic in nature. All body systems are affected. For example, cocaine and crack cocaine use has been linked to heart attack, irregular and increased heartbeat, enlarged heart, brain hemorrhage, acute high blood pressure, renal disorder and impaired respiratory function.
Methamphetamine use causes leakage of the brain blood-barrier, brain edema and morphological abnormalities of brain cells. Marijuana use is associated with cardiovascular disease, impaired respiratory function, negative effect on cognition and increased risk of psychosis and psychiatric disorders. Adolescents and youth are most at risk for these conditions, which may have lasting negative effects on their psychological, emotional and mental health development. And these are just a few of the medical problems associated with drug use/addiction, none of which prisons or their programs are usually equipped to address.
Addiction, as with many other brain diseases, has embedded behavioral and social-context aspects that are important part of the disorder itself. These are played out in aggressive anti-social behaviors, engagement in criminal activities, impaired social interaction, willpower dysfunction and psychotic behavior. Such behaviors have enormous costs for society in terms of direct and indirect economic and social consequences and include: costs on human and financial resources, productivity lost, road and domestic accidents related to drug abuse, health care costs related to mental disorders and diseases that develop in relation to drug dependence, such as HIV.
Therefore, a different approach is needed to address the health, social and security results of drug addiction. Alternatives to imprisonment can prevent and reduce drug use and dependence and drug-related harms to health and society. Research has shown, and many practitioners working in the field support the findings, that alternatives to imprisonment offer workable solutions for addressing the health, security and development challenges emanating from drug addiction.
Many European countries have taken the lead in adopting alternative options for persons addicted to drug with regard to the type of offence committed. The US is still lagging behind. A number of International and UN Mandates support alternatives to incarceration as a preferred strategy for successfully treating drug addiction.
One UN agency has declared:
Member states should develop within the criminal justice system, where appropriate, capacities for assisting drug abusers with education, treatment and rehabilitation services. Close cooperation between criminal justice, health and social systems is a necessity and should be encouraged.
Drug Treatment City Partnerships is an initiative funded by the European Commission, and coordinated by the Inter-American Drug Abuse Control Commission and the Secretary for Multidimensional Security of the Organization of the American States. Their objectives are: a) to sensitize prosecutors and judges to drug treatment and rehabilitation as an alternative to incarceration for drug-dependent offenders, b) to help improve the policymaking capacity of partner cities to support the provision of drug treatment by creating a learning partnership among programs in different cities, c) to build an exchange partnership among cities in Latin America, the Caribbean and the European Union that will mutually reinforce the knowledge, skills and experience they need to better serve their problematic drug users and d) to allow participants in the judicial system, including individual judges and prosecutors, treatment centers, individual healthcare professionals, city officials and national representatives in the area of drug treatment to study and compare different models of treatment alternatives to incarceration.
