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We Are Supposed To Be Rehabilitating Them – The Failure of The Prison System

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“The current design of prison systems don’t work. Overly punitive approaches used on violent, angry criminals only provide a breeding ground for more anger and more violence,” said criminal justice expert Joel Dvoskin, PhD, of the University of Arizona.


Presenting at the American Psychological Association’s 117th Annual Convention, Dvoskin further explained that, “Prison environments are replete with aggressive behaviors, and people learn from watching others acting aggressively to get what they want” (Dvoskin, 2016).


What we should be doing instead, says Dvoskin, is applying behavior modification and social learning principles, such as systematic reinforcement of pro-social behaviors. While punishment can be effective in changing behavior, but it only works in the short term, and should be used in psychologically informed and effective ways.


“Punishment should not be one-size-fits-all” (Dvoskin, 2016).


Dvoskin also suggests that a better understanding of what may be behind the criminal behavior, will lead to more effective treatment approaches. He explains, “A person who commits crimes when drunk but not when sober is likely suffering from an alcohol problem. Treating the alcohol problem may diminish the criminal behavior” (Dvoskin, 2016).


Decreasing prison populations needs to be more of a priority, and bringing job training back into prisons are also two fundamental priorities of effective rehabilitation and re-entry into society – and act to reduce recidivism. Dvoskin explains, “There is not enough supervision to allow prisoners to work and build skills. This makes it very hard to re-enter into the civilian world and increases the likelihood of going back to prison” (Dvoskin, 2016).


Dvoskin also warns that without these changes, the astounding number of American adults in prison – 7 million – can be expected to increase as more children are growing up without fathers and are at risk for continuing the vicious cycle of criminal behavior (Dvoskin, 2016).


“If we don’t make the changes now, we will see these numbers go up” (Dvoskin, 2016).


And one Canadian study showed that incarceration may predispose a person to another, equally troubling problem after their release – a drug overdose.


Obtaining data from the Ontario Ministry of Community Safety and Correctional Services between 2006 and 2013 on the nearly 50,000 people released annually from Ontario provincial correctional facilities, Dr. Nav Persaud, a scientist with the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and his team from the University of Toronto looked at incarceration release records with coroner reports in the Coroner’s Information System to determine how many of these people died of drug overdoses within one year of their release.


“Previous research has speculated that the higher risk for overdose immediately following release can be attributed to periods of no or less frequent drug use while individuals are incarcerated. Once released, these individuals may not realize that their tolerance has diminished and can accidentally overdose, explains Dr. Persaud (Persaud, 2016).


What Dr. Persaud and his team found should have us all paying attention. Among those recently released from prison, the fatal overdose rate was 12 times as high as the general population. More specifically, one in ten adults who died of a drug overdose in Ontario between April 2006 and March 2013 had been released from a provincial correctional facility within one year. Moreover, overdose death rate was highest immediately following release – nine per cent of the deaths occurred in the first two days and 20 per cent within the first week (Groot et al., 2016).


As for what drugs were most involved, the majority of the overdose deaths involved opioids (Groot et al., 2016).


“We were surprised at how high the fatal overdose rate was among those who were recently released from provincial custody – almost 12 times higher than the general population” (Persaud, 2016).


An important point, notes Dr. Persaud, is that in over half of these cases, there was a person present who could have intervened. He explains, “At least some of these deaths are preventable and there may be opportunities to prevent overdose deaths by supporting this vulnerable group – during incarceration and immediately following release” (Persaud, 2016).


“Future research and policy should focus on immediate interventions such as directing people to treatment programs and providing better access to naloxone, drug substitution therapies and overdose prevention education” (Persaud, 2016).


And while some have argued that the mental illnesses and psychiatric disorders common in inmates predated their incarceration, new research shows that incarceration itself is often the cause of psychiatric distress.


Using data from the National Comorbidity Survey Replication, which took place between 2001 and 2003, Jason Schnittker, an associate professor of sociology at the University of Pennsylvania,  Michael Massoglia, an assistant professor of sociology at the University of Wisconsin-Madison, and Christopher Uggen, a professor of sociology at the University of Minnesota examined the relationship between incarceration and psychiatric disorders after statistically adjusting for influences that might affect both, including an impoverished childhood background.


Their results are compelling – there is a clear and long-lasting relationship between incarceration and psychiatric conditions that adversely affect one’s mood, such as major depression (Schnittker et al., 2016).


“These conditions, in turn, are strongly related to other impairments, including a diminished capacity to form social relationships and to focus on daily activities including work,” explains Schnittker (Schnittker, 2016).


“Although often neglected as a consequence of incarceration, mood related conditions might explain some of the difficulties former inmates experience following release” (Schnittker, 2016).


Schnittker and his team suggest that mental health treatment become an integral part of reintegration into society and encourage efforts to facilitate this.


“Even though many former inmates want to get back on their feet after release, they experience numerous difficulties in doing so, some legal, some social, and some personal. Being depressed probably makes all of these obstacles even more difficult to overcome. Reentry requires motivation, and depression can rob you of that” (Schnittker, 2016).


In the case of African American males, the criminal justice system is one of negative reinforcement that maintains biases and overlooks what otherwise might be effective rehabilitative efforts.


Looking at decades of data concerning the African American population rates of incarceration and subsequent health issues, Dr. William D Richie, assistant professor in the Department of Psychiatry and Behavioral Sciences at Meharry Medical College, and his team compiled the first comprehensive report on the correlation between the incarceration of African American males and substance abuse and other health problems in the United States.


Concluding that the moral and economic costs of current racial disparities in the judicial system are fundamentally avoidable, the study highlighted the fact that with regard to African American males in the prison system, individual States are paying more to lock up non-violent offenders than they are for education, since 60% of incarcerations are due to non-violent, illicit drug-related crimes. Dr. Richie and his team also point to a previous study from 2,000 showing that the total cost of substance abuse – be it incarceration, crime or treatment – is over $500 billion per year for the U.S. (Mukku et al., 2015).


Further, even though crime rates have dropped across the country over the past two decades, incarceration rates have continued to skyrocket – with black people accounting for a largely disproportionate 38% of inmates. More alarmingly, incarceration rates for African American males jumped 500% between 1986 and 2004 (Mukku et al., 2015).


The study also found the same link between incarceration and substance abuse as did Persaud and his team – in short, incarceration increased chances of substance abuse even where no previous history of substance abuse existed (Mukku et al., 2015).


“Spending money on prevention and intervention of substance abuse treatment programs,” Dr. Richie notes, “will yield better results than spending on correctional facilities” (Richie, 2015).


“Instead of getting health care and education from civil society, African American males are being funneled into the prison system. Much of this costly practice could be avoided in the long-term by transferring funds away from prisons and into education” (Richie, 2015).



According to Richie, these results can largely be explained by the system of negative reinforcement of disruptive behavior that emerges as early as preschool, where young children of color are often treated more harshly for behavior similar to their white peers.


One step in the right direction, notes Dr. Riche, would be to have more black teachers during the early stages of development. He explains, “From a behavioral scientific perspective, having teachers that look like the students and the parents of students from an early age could go a long way in changing perceptions of authority for black youth” (Richie, 2015).


Yet getting more African American teachers means getting them out of the prison system and into the higher education system. The result, argues Dr. Richie, would be that in the long-run, alternatives to prison would cost the United States much less and improve the lives of African American males, their families, and the entire country (Richie, 2015).


And sadly, the effects of incarceration extend beyond the one behind bars – often to their children.


Although women only comprise 7 percent of the overall prison population, growth in the rate of incarceration for females is outpacing that of males, with a 64 percent growth in commitments to prison between 1991 and 2011 for women, compared to 22 percent for men. The rise in incarceration rates for women are the result of sentencing guidelines, mandatory minimum sentencing, increased sentences for certain crimes, and the War on Drugs.


Moreover, two-thirds of women in prison are mothers and generally have greater responsibility in child-rearing than incarcerated fathers, and children with incarcerated mothers are more likely to live with relatives away from home, which increases the risk of attachment disruptions, separation anxiety, depression, preoccupation with the loss of a parent, and sadness, according to existing research.


To examine the effects of maternal incarceration on children Lisa Muftic, Leana Bouffard, and Gaylene S. Armstrong of the Department of Criminal Justice and Criminology drew from data collected by the National Longitudinal Survey of Adolescent to Adult Health (Add Health), a 20-year study that follows a nationally representative sample of youth who were in 7th to 12th grades in 1994-95. Then the researchers examined the respondents’ social, economic, psychological, and physical well-being, as well as information on the family, neighborhood, community, school, friendships, peer groups, and romantic relationships – specifically comparing adult children whose mothers had been incarcerated to those whose mothers had not been in prison or jail.


Even after considering common correlates of criminal behavior, the results were telling: Children of incarcerated mothers are twice as likely to be arrested, convicted and incarcerated as adults. Further, among the adult children of incarcerated mothers, participants were three times more likely to report their mother’s absence and half as likely to be a college graduate (Muftic et al., 2015).


“The current findings serve to bolster the contentions regarding the unintended consequences of maternal incarceration that include collateral damage to the children these women are forced to leave behind during imprisonment” (Muftic, 2015).


Compounding the problem, the researchers note, is that, during the time of maternal incarceration, fathers may also be in prison (Muftic et al., 2015).


“The absence of mothers significantly increases the likelihood that offspring are actively involved in the criminal justice system in the future. Maternal incarceration, above and beyond maternal absence, demonstrated a unique impact on offspring that may be due to the offspring’s extended displacement from the home, increased attachment disruption or other negative psychosocial effects” (Bouffard, 2015).


The ripple effects of incarceration are so pronounced that many researchers liken it to an infectious disease.


Using the same modeling techniques used for infectious disease outbreaks, researchers at Virginia Tech argue that small but significant differences in prison sentences can lead to large differences in incarceration rates – such as the incarceration rate that has nearly quadrupled since the U.S. declared a war on drugs, or the incarceration rates for black American that are six times higher than for white Americans (Lum et al., 2016).


Collecting publicly available data from a variety of sources, the researchers generated a realistic, multi-generational synthetic population with contact networks, sentence lengths, and transmission probabilities – a model is comparable to real-world incarceration rates.


Both the model and actual statistics show large discrepancies in incarceration rates between black and white Americans and, subsequently, the likelihood of becoming a repeat offender is high.


Further, incarceration can be “transmitted” to others, the researchers say. Incarceration can increase family members’ emotional and economic stress as well as their own risk of future incarceration (Lum et al., 2016).


Another problem is the “official bias” that leads police and the courts to pay more attention to the incarcerated person’s family and friends, thereby increasing the probability they will be caught, prosecuted and processed by the criminal justice system (Lum et al., 2016).


“Regardless of the specific mechanisms involved, the incarceration of one family member increases the likelihood of other family members and friends being incarcerated” (Lum 2016).


In Lum’s model, incarceration becomes a disease where the incarcerated are infectious to their social contacts – their family members and friends most likely affected by their incarceration.


“Criminologists have long recognized that social networks play an important role in criminal behavior, the control of criminal behavior, and the re-entry of prisoners into society,” notes James Hawdon, a professor of sociology in the College of Liberal Arts and Human Sciences (Hawdon, 2016).


“Research clearly shows that this epidemic has had devastating effects on individuals, families, and entire communities” (Lum, 2016).


The argument that Lum and her team make is not only that harsher sentencing may actually result in higher levels of criminality, but reducing the growing incarceration epidemic depends on understanding social influence and its impact on criminal behavior.


For those at The National Institute on Drug Abuse it is an “epidemic of mass incarceration” that is fueled by inadequate treatment of addiction and mental illness in the community.


Pointing to policy changes over the last 30 years, such as severe punishment for drug users as a result of the nation’s “War on Drugs” Josiah D. Rich, M.D., M.P.H., director of the Center for Prisoner Health and Human Rights, Sarah E. Wakeman, M.D., of Massachusetts General Hospital, and Samuel L. Dickman, A.B., of Harvard Medical School (formerly with Brown University), note that over the past 40 years, the number of people in U.S. prisons has increased by more than 600 percent. With 1 in 100 Americans currently in prison or jail, no other country comes close to imprisoning as many of its citizens as the U.S. Further, low-income and minority populations are disproportionately affected by this epidemic of mass incarceration, further exacerbating racial and socioeconomic health disparities (Rich et al., 2016).


“More than half of all inmates have a history of substance use and dependence or mental illness, yet they are often released to the community without health insurance or access to appropriate medical care and treatment” (Rich, 2016).


The largest facilities housing psychiatric patients in the U.S. are not hospitals but jails, explain the researchers. Even more telling, major depression and psychotic disorders are four to eight times as prevalent among inmates as in the general population, and yet only 22 percent of state prisoners and 7 percent of jail inmates receive mental health care while incarcerated (Rich et al., 2016).


Like mental illness, the prevalence of infectious diseases in the prison system has also increased. As many as a quarter of all HIV-positive Americans and one in three individuals with hepatitis C will inhabit a correctional facility each year. Inmates are also disproportionately affected by chronic diseases, such as hypertension and diabetes (Rich et al., 2016).


What we are missing, notes Wakeman, is a tremendous opportunity to interrupt the revolving door of criminality. He explains, “For some inmates, incarceration may represent their first intersection with the medical community, offering an invaluable opportunity to diagnose and treat the overrepresented rates of infectious and chronic diseases, addiction and mental illness” (Wakeman, 2016).


“Physician awareness and involvement with this public health crisis will benefit not just the millions of Americans who cycle through corrections each year, but also the communities to which they return” (Wakeman, 2016).


Rich concludes that a new evidence-based approach is desperately needed: “Locking up millions of people for drug-related crimes has failed as a public-safety strategy and has harmed public health in the communities to which these men and women return” (Rich, 2016).


“The medical community and policymakers must advocate for alternatives to imprisonment, drug-policy reform and increased public awareness in order to reduce the consequences of mass incarceration” (Rich, 2016).


Stephen Jones, M.D., U.S. Public Health Service, Commissioned Corps (ret) and the Centers for Disease Control and Prevention (CDC), concurs: “In light of the recent US Supreme Court decision that California’s prisons are unconstitutionally overcrowded and fail to deliver minimal care to prisoners with serious medical and mental health problems, this call by physicians to address the national epidemic of incarceration is timely” (Jones, 2016).


To understand criminal behavior we have to understand the system in which it exists – a system that is plagued by bias, mis-prediction, and often reinforcement of the very factors that fuel criminality.

We Are Supposed To Be Rehabilitating Them – The Failure of The Prison System

Claire Dorotik-Nana, LMFT

Claire Dorotik-Nana LMFT is a licensed marriage and family therapist specializing in post-traumatic growth, leveraging adversity, and other epic human achievements. Claire has written multiple continuing education courses for Professional Development Resources, Zur Institute, and International Sport Science Association. Claire has also authored multiple books, including:
Leverage: The Science of Turning Setbacks into Springboards and On The Back Of A Horse: Harnessing The Healing Power Of The Human-Equine Bond. For more information about Leveraging Adversity or Claire, visit

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APA Reference
Dorotik-Nana, C. (2019). We Are Supposed To Be Rehabilitating Them – The Failure of The Prison System. Psych Central. Retrieved on August 4, 2020, from


Last updated: 13 Apr 2019
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