A Look Inside: The Lack of Treatment for Substance Use Disorders in State Jails

Kayla Roane

It isn't news to most of us that rehabilitation services are lacking in the carceral system in Texas. We know that our system focuses almost exclusively on punishment, as opposed to treatment, with many believing that incarcerated individuals are a menace to society and cannot or will not recover. Texas is unique in that we have state jail felonies, the majority (45%) of which are low-level drug offenses, with many suffering from substance use disorders. Substance use disorder (SUD) is a treatable mental disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like drugs, alcohol, or medications. It is a public health issue, not a criminal one, and should be treated as a mental, physical, and behavioral health concern. However, many government officials and people in our society are poorly educated on the subject, or worse, it simply does not cross their minds. I am an individual in long-term recovery who has experienced a lack of effective treatment inside a state jail facility. I will be sharing from my personal experience what it was like for me (and so many others), what was lacking or ineffective, and what needs to change.

My Pathway Into the System 

I battled alcoholism and drug addiction, along with mental health issues and unprocessed trauma for over a decade. It led me to losing everything and ending up on the streets, doing what I needed to in order to survive. I was in and out of county jail for several years, never receiving ANY kind of treatment for my substance use disorder, then turned back out onto the streets the same as I went in, except on probation. Since my underlying issues were never addressed, I used time and time again, even though I desperately wanted to end the cycle. Warrants were issued for my arrest several times for violating the terms of my probation until I was finally out of chances.

I was arrested for the last time in November 2016. This was the moment I was finally ready, so I cried and begged to go to treatment. The judge told me she no longer cared what I wanted, and I would be doing the maximum sentence of two years in a state jail facility, with no possibility of early release. I was upset at first but quickly came to accept her decision. I planned to sign up for any and all programs offered in that facility that could help me with my recovery.

I arrived at Lucile Plane State Jail in Dayton, TX, in early 2017. I didn't realize until I got there how ridiculous most of these programs were. I vaguely remember taking an assessment and IQ test; however, these led to nothing and were just another protocol box to check. The services they offer are not monitored for fidelity. If they are, the measures of success are often outputs (e.g., # people served), not outcomes (e.g., without relapse 3, 6, 9 months out). 

What Didn’t Work for Me: The Most Common “Treatment” on the Inside

"Turning Point" was the SUD program offered during my sentence and the biggest joke of them all. Most people I met told me they entered the program because they heard it could help them get out early, which has less to do with rehabilitation and more to do with the judge and county you're coming from. I knew I wasn't getting released early; I signed up because I wanted help.

The counselors in Turning Point were misinformed and wildly offensive. One counselor told people to be careful about who they used the bathroom after because they can catch AIDS from the toilet seat. When the "counselors" weren't in the pod giving their 30-minute misinformed spiel, the incarcerated women ran the program. There was no guidance or oversight; all that mattered was that people were out of their beds for group every morning. Most of the women who volunteered to lead the groups wanted to be in a position of power, which only caused more chaos and drama between the women.

Turning Point was not a difficult program to get into. Many women on the unit didn't sign up for it because the strict guards worked those dorms, and they didn't want to catch cases. Cases, or write-ups, could lead to loss of privileges (commissary, visits, etc.), and their fears weren't irrational. I took my recovery seriously and did my best to follow the rules, yet I still received a case almost weekly. Once, in 120-degree conditions, I received a case for being in my sports bra in my personal bunk space. A sergeant wanted to embarrass me for not wearing my jail-issued uniform, so she paraded me around the other dorms shirtless while she did her checks. If I had known I would be dealing with this harassment, I, too, would have avoided the program. What I needed was foundational education and guidance on how to treat my disease; this program provided neither.

What Did “Work” for Me (Sort of): The Limited Effective Treatment on the Inside 

Cognitive Behavioral Therapy (CBT) was the most beneficial class you could take in the unit and one of the most difficult to get into. The waiting list was at least six months, so anyone with that sentence length was automatically excluded. Cognitive Behavioral Therapy is based on the concept that negative/distorted thoughts, feelings, and belief systems cause a cycle of unhealthy or toxic behaviors. CBT aims to break down overwhelming problems into smaller parts to change negative patterns and improve the way you feel. It has been used to treat a number of different mental health conditions — such as Borderline Personality Disorder, Bipolar Disorder, Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, and more. 

Research shows that CBT program(s) are “among the most effective [carceral] interventions,” with multiple empirical studies reporting a reduction in recidivism by 20 to 30%. However, I can vouch that CBT alone is not enough. 

You see, for those struggling with substance use disorders, the negative/distorted thoughts, feelings, and belief systems are rarely the only issue. According to the National Institute on Drug Abuse, of the 20.3 million adults that struggle with substance use disorders in the U.S., 37.9% also have mental illnesses (aka comorbidity). This means that without treating the underlying issue that may be causing the substance use, a one-shot CBT program may not be enough. 

There are also physical barriers that make maintaining one’s recovery post-release quite difficult, such as knowing how to access and afford continued therapeutic care, while resisting the urge to eliminate their stress and ease their fears by self-medicating. Feeling motivated to recover is a great start; however, the motivation can fall flat when there's no accessible pathway to sustainable recovery. So, not only is it important for a program to show that it can be effective, but also that it can foster and promote self-management while also providing access to resources within one’s community (e.g., a continued model of care).

The Problem at Hand: Limited Effective Treatment with No Reintegrative Support 

The lack of effective treatment for substance use disorders and reintegration services makes it difficult to begin treatment while incarcerated or successfully enter into recovery once released. A significant part of my success had to do with starting over fresh in a new city and not returning home to the people and places that would likely lead me to a relapse. While incarcerated, I wrote letters using the chapel's outdated resources to find a facility that would take me upon release, but I never heard back from a single one. Thankfully, I was able to get a bed in a treatment center with the help of a peer support specialist who came to visit the program dorms. According to the Bureau of Justice Assistance, peer support specialists have been shown to “enhance one’s recovery capital,”  which includes key factors for maintaining/sustaining one’s recovery (e.g., family, support groups, work, home life, education, personal aspirations). 

Once I moved out of the treatment dorm and into general population, I met many people who wanted the same opportunity I had, but only had access to the same old resources the chapel gave me and with no peer support specialists. 

It’s no wonder the recidivism rates are substantially higher for state jail facilities (rearrest: 60.1%, reincarceration: 20.5%) compared to the rates of those paroled from prison (rearrest: 46.5%, reincarcerated: 14.7%). Not only do prisons have more institutional programming, recovery services, and accessible peer support specialists, but they are also released on parole,  providing some semblance of a continued support system upon release. Although the parole system is deeply flawed, there is no “hand to hold” when released from state jail. Instead, you are “flat-released,” without supervision, without peer support, without a sense of self-management, and with no links to resources within your community for continued therapeutic care.  

A Proposed Solution: Support a Holistic Pathway to Recovery for Texans in State Jails 

When I was released from Lucile Plane State Jail, I knew that I needed to go into long-term treatment where I had supervision, accountability, and community — if I wanted a shot at living successfully in recovery. As ready as I was to heal, I admit it was difficult for me to commit to another year in an institution. While long-term term treatment was proven to be highly beneficial for me, I could not access it until I was released. Unfortunately, many do not stay sober long enough once released to gain access to these treatments, and due to the opioid epidemic, many won’t stay alive long enough and will never receive the help they need. This introduces a seemingly simple question: What if people got the help they needed while they were serving out their sentences?

Effective treatment for substance use disorder requires a holistic (or wraparound) approach, and a process of healing on all levels: mental, physical, emotional, communal, and spiritual. The program I enrolled in post-release helped me understand and internalize these truths. Through that experience and continued work on myself, I celebrated 7 years in recovery this past November and reached a level in my healing journey that I never imagined was possible. 

Each year, the Texas Department of Criminal Justice (TDCJ) releases, on average, over 12,800 people from state jails. Of the 17 state jails owned and operated by TDCJ, only six offer programming that is targeted at addressing substance use disorders — the Pre-Release Substance Abuse Program (PRSAP), the Pre-Release Therapeutic Community (PRTC), and the State Jail Substance Use Program (SJSAP) —while the remaining eleven are left to the programming available provided via third-party vendors or volunteers. 

Even more important is that there does not appear to be any sort of evaluation on record for the programming that TDCJ does provide for substance use; at least not for state jail facilities. This means that while the department may be making an effort to provide some sort of research-based programming, they have not made an effort to determine whether that programming is working for the population they intend to serve. 

Again, CBT played a small part in my successful recovery, but that program does not consider the obstacles and challenges we will face on the outside. It does not address any core issues of trauma or substance use disorder. And even though peer support specialists were the connection to my long-term healing once released, I cannot stress enough how unequal accessibility to this support is and how their effectiveness is determined by their desire/willingness to be there (i.e., they are volunteers!).

Looking Forward: How You Can Help  

In order for us to move state jails away from their notoriously high recidivism rates, it is important that we take a closer look, not just at whether or not programming is being offered to people within these facilities, but that the quality and fidelity of those programs can be spoken to as well. 

A 2020 Substance Abuse and Mental Health Services Administration survey reveals an estimated 11.3 million people in Texas live with substance use disorder. This disorder does not discriminate, not by age, race, or income. Substance use problems can be triggered by a variety of factors, including environmental stressors, social pressures, trauma, and genetic predisposition. This makes low-level drug offenses that stem from substance use a public health concern, not a criminal justice matter. 

So, what can you do if you want to help? Educate yourself, educate others, and have difficult conversations about the realities of substance use disorders and the role carceral institutions truly play. Seek to get help for those you love from trained mental health professionals. Perhaps look into becoming a peer support specialist to help people reintegrate back into our communities. Last but not least, contact your state senator or representative today and express your concern for the lack of effective treatment for people with substance use disorders in Texas’ state jails! Every little bit helps.