New CASA* Report Finds: 65% of All U.S. Inmates Meet Medical Criteria for Substance Abuse Addiction, Only 11% Receive Any Treatment | Center on Addiction

New CASA* Report Finds: 65% of All U.S. Inmates Meet Medical Criteria for Substance Abuse Addiction, Only 11% Receive Any Treatment

New CASA* Report Finds: 65% of All U.S. Inmates Meet Medical Criteria for Substance Abuse Addiction, Only 11% Receive Any Treatment

NEW YORK, N.Y., February 26, 2010

Of the 2.3 million inmates crowding our nations prisons and jails, 1.5 million meet the DSM-IV medical criteria for substance abuse or addiction, and another 458,000, while not meeting the strict DSM-IV criteria, had histories of substance abuse; 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 violation; or shared some combination of these characteristics, according to Behind Bars II: Substance Abuse and America’s Prison Population. Combined these two groups constitute 85% of the U.S. prison population.

The new 144-page report released today by CASAColumbia (CASA) at Columbia University also reveals that alcohol and other drugs are significant factors in all crime. In 2006, alcohol and other drugs were involved in these inmate offenses:

  • 78% of violent crimes
  • 83% of property crimes
  • 77% of public order, immigration or weapon offenses; and probation/parole violations

The CASA report found that only 11% of all inmates with substance abuse and addiction disorders receive any treatment during their incarceration. The report found that if all inmates who needed treatment and aftercare received such services, the nation would break even in a year if just over 10% remained substance and crime free and employed. Thereafter, for each inmate who remained sober, employed and crime free the nation would reap an economic benefit of $90,953 per year.

“States complain mightily about their rising prison costs; yet they continue to hemorrhage public funds that could be saved if they provided treatment to inmates with alcohol and other drug problems and stepped up use of drug courts and prosecutorial drug treatment alternative programs,” said Susan E. Foster, CASA’s Vice President and Director of Policy Research and Analysis.

Joseph A. Califano, Jr., CASA’s Chairman and President and former U.S. Secretary of Health, Education, and Welfare, called the nation’s current prison policies, “Inane and inhuman. Between 1996 and 2006, the U.S. population grew by 12%. Over that same period, the number of adults incarcerated grew by 33% to 2.3 million inmates and the number of inmates who either met the DSM-IV medical criteria for alcohol or other drug abuse and addiction or were otherwise substance involved shot up by 43% to 1.9 million inmates. The tragedy is that we know how to sharply reduce the costs of incarceration and the crimes committed by substance-involved offenders.”

The report also noted that in 2005, federal, state and local governments spent $74 billion on incarceration, court proceedings, probation and parole for substance-involved adult and juvenile offenders and less than 1% of that amount—$632 million--on prevention and treatment for them.1

Twelve years ago, CASA released Behind Bars: Substance Abuse and America's Prison Population. CASA prepared this report to see if any progress had been made in reducing the number of substance-involved offenders behind bars and to examine and identify promising practices for cost-effective investments. To conduct this study, CASA researchers analyzed data on inmates from 11 federal sources, reviewed more than 650 articles and other publications, examined best practices in prevention and treatment for substance-involved offenders, reviewed accreditation standards and analyzed costs and benefits of treatment.

“Despite increased recognition of the problem and its potential solutions, we have made no progress in reducing the number of substance-involved inmates crowding our prisons and jails. The United States has less than 5% of the world’s population and we consume two-thirds of the world’s illegal drugs and incarcerate almost a quarter of the world’s prisoners, more than 8 of 10 of whom have some substance involvement,” said Califano.

The CASA report also found that compared to non-substance involved inmates, substance-involved inmates are not only likelier to be re-incarcerated, begin their criminal careers at an early age, and have more contacts with the criminal justice system, but they are also:

  • 4 times likelier to receive income through illegal activity
  • Twice as likely to have had at least one parent who abused alcohol or other drugs when they were children
  • 41% likelier to have some family criminal history
  • 29% less likely to have completed at least high school
  • 20% likelier to be unemployed a month before incarceration

Other Key Findings

  • In 2006, an estimated 1 million substance-involved inmates were parents to more than 2.2 million minor children. Three-fourths of these children were age 12 or younger
  • Alcohol is implicated in the incarceration of more than half of all inmates in America; illicit drugs are implicated in three-fourths of incarcerations
  • Contrary to public perception, only 2% of all inmates are incarcerated for marijuana possession as their controlling or only offense

A Call for Action
To reduce the number of substance-involved inmates crowding our prisons, improve the health of inmates and reduce crime, the CASA report offers specific recommendations in its call for action by the nation’s criminal justice systems and federal, state, and local governments including these:

  • Use trained health care professionals to screen, assess and treat substance-involved offenders and provide care for co-occurring physical and mental health problems
  • Provide comprehensive pre-release planning and aftercare to continue treatment services for inmates with substance use disorders
  • Require addiction treatment for inmates to be medically managed
  • Expand the use of treatment-based alternatives to jail and prison
  • Require accreditation for prison- and jail-based treatment programs and providers

“This report lays out the steps we need to take to address the treatment needs of offenders while holding them accountable for their crimes,” noted Foster. “We do not as a nation refuse to provide treatment for other chronic ailments like heart disease or diabetes. We should do so for addictive disorders, especially when the added benefits of treatment for offenders include significant reductions in crime and its costs to society.”

CASA is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society. CASA and its staff of some 60 professionals has issued 71 reports and white papers, published 3 books, conducted demonstration programs focused on children, families and schools at 241 sites in 94 cities and counties in 35 states plus Washington, D.C. and 2 Native American reservations, held 19 conferences attended by professionals and others from 49 states and several foreign countries, and has been evaluating the effectiveness of drug and alcohol treatment and prevention in a variety of programs and drug courts. CASA is the creator of the nationwide initiative Family Day—A Day to Eat Dinner With Your ChildrenTM – the fourth Monday in September—the 27th in 2010—that promotes parental engagement as a simple and effective way to reduce children’s risk of smoking, drinking and using illegal drugs. The most recent CASA book, How To Raise a Drug Free Kid: The Straight Dope for Parents by Joseph A. Califano, Jr., a practical, user friendly book of advice and information for parents, is widely available in paperback and book events can be arranged for parents. For more information visit

*CASAColumbia at Columbia University is neither affiliated with, nor sponsored by, the National Court Appointed Special Advocate Association (also known as "CASA") or any of its member organizations with the name of "CASA

1 From CASA’s 2009 Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets report.


Director of Digital Communications

(212) 841.5225


Media Specialist

(212) 841.5206 ​


Communications and Digital Associate

(212) 841.5206

Newsletter Additional Information

Newsletter Additional Information

Thank you for subscribing

This information will be used to better customize your experience and help inform future tools and features on our website.

Additional Information
What brought you to our website?