The Radical Shift in Drug Treatment in California Prisons

In January 2020, the California Department of Corrections and Rehabilitation (CDCR) began implementing the largest drug treatment program in prisons in the country. Efforts were made to curb an alarming surge in overdoses in California prisons: in 2019, 64 people incarcerated by CDCR died from an overdose, making it the second leading cause of death.

This May, however, the Union of American Physicians and Dentists, the largest union of licensed physicians in the United States, based in Sacramento, questioned the further introduction of the drug treatment program, which provides inmates with the three most effective opioid drugs. 138 doctors, who represent one-third of all doctors working in California state prisons, petitioned them saying they support drug-assisted treatment but are concerned about the branded drug Suboxone and its potential for abuse in prison facilities.

Subboxone is controversial as it has a “street value” both inside and outside the prison. However, according to DEA, it’s a safer drug than methadone, with a lower risk of overdose and illicit use.

CDCR’s program offers medical treatment alongside in-depth counseling and peer support – care that is literally unknown in most US prisons. At San Quentin State Prison, the program has had a marked impact on people who have long struggled with drug addiction and previously had no support or treatment. It has also become a avenue for present and past incarcerated people who have successfully overcome their addiction to counsel others who are trying to do the same.

“This is a harm reduction strategy,” said Alex Tata, an advisor to the San Quentin Program, of the assistance. “Addiction is a symptom of something bigger – until you fix the root of the problem, the addiction won’t go away,” she continues. “That’s why I like this work so much, because it hits the whys of the whys.”


Substance abuse has become an urgent crisis in America’s prisons. From 2001 to 2018, the number of people who died of drug or alcohol poisoning in state prisons increased by more than 600%, according to the Bureau of Justice Statistics. In county prisons, overdose deaths rose by over 200%.

But treatment is rare, even when people’s crimes are caused by recurrent substance abuse. A 2019 report by the National Academy of Sciences showed that only 5% of people with opioid use disorder were treated in prisons and prisons.

Kevin Flanagan, who has been based in San Quentin since 2017, says his experience with heroin led him to criminal activity. “When I was 32 I thought I’d be an addict my whole life, I had put up with it.”

He hadn’t received holistic treatment until he was early admitted to the CDCR program in February 2020. He started with Medicated Assisted Treatment (MAT) and an in-class program called Integrated Substance Use Disorder Treatment (ISUDT).

Flanagan says his Suboxone recipe helps keep his desire to use drugs at bay. “It’s just because of the medication, but with the class it really changed my view of things.” The importance of treatment in class is “to learn to accept myself and my problems, to objectively take a step back and my problems like that to consider that I can deal with it ”.

CDCR’s program lasts about a year. Doctors place participants in the program, counselors use “motivating interviews” to persuade them to stay. These are one-on-one interviews in which consultants ask clients open questions about their reluctance to participate. The counselors give affirmations to clients and “roll with the resistance,” says Shadeeda Yasin, an advisor on the program.

They often sum up what the customer tells them to “open the door to a dialogue about the customer’s program delay,” she adds.

When the participants join, they will take part in two-hour ISUDT sessions on Monday, Wednesday and Friday in groups of no more than 12 people. Each session begins with a check-in, in which current feelings are expressed.

“We need to know what this person is going through at this time,” says Raul Higgins, a certified and detained counselor. “Sometimes a client will close after experiencing something traumatic, such as a death in the family.”

After checking in, the group goes through a grounding meditation that takes 3-5 minutes of centering and deep breathing. Then the group begins the curriculum in the workbook Helping men recover.

The workbook – based on research, theory and clinical practice – is the first gender-equitable and trauma-informed addiction treatment for men. “The program explores core issues of the social construction of masculinity, the role of anger in men’s lives, the effects of abuse and violence on men’s relationships, and perceived male privilege,” says Higgins. As part of an effective treatment plan, he adds, “it recognizes the physical, emotional, psychological and spiritual aspects of addiction”.

Tata, who was trained by CDCR to teach two ISUDT courses in San Quentin, says the courses also help students develop life skills in relapse prevention. “It helps them stay on track and achieve the goals they want.”

CDCR is currently measuring the impact of the first year of the program. While the department’s official 2020 mortality information is pending, preliminary data shows a decrease in overdose deaths, according to Ike Dodson, communications manager for the program. In June of this year, 13 students became the first to graduate from the new treatment model. As of September 30, all 34 state prisons were treating 15,822 patients for addiction and 12,657 program participants were receiving drug treatment.

“The employees are working hard to expand access to these services, and [the department] will continue to hire, provide enhanced training, provide technical support, and expand its network of vendors, ”said Dodson.

In San Quentin, counselors offer a model of personalized treatment despite the prison environment in which psychiatric care is provided is lacking. Cristina Islas-Banthi, Assistant Program Director for the San Quentin MAT / ISUDT program, stresses the importance of “drug counselors’ willingness to be open to learn what is needed to improve life,” and clients, “to Getting guidance and help ”. She adds, “I don’t want participants to feel like a number – we have to make people feel like a number, they are people.”

However, external consultants do not do the work alone; A key component of the program is peer support for former and current incarcerated people who have overcome their addictions. In 2012, Higgins graduated as a Certified Alcohol and Drug Advisor I, an Internationally Certified Alcohol and Drug Advisor, and a Certified Relapse Prevention and Denial Management Specialist for the CDCR’s Rehabilitation Programs Department.

After completing his training, he immediately moved to San Quentin to work side by side with Yasin as a consultant. All counselors, incarcerated and non-incarcerated, meet twice a week to discuss the curriculum or topics that may arise in class. “When clients see imprisoned mentors working with someone like me, it empowers the imprisoned population and boosts self-esteem,” says Yasin. “It is important to have good cooperation with imprisoned colleagues.”

“Today I am a man of vision and determination,” says Higgins. “One of the toughest jobs in my nine years of service is helping and nurturing men with addictions, and MAT is very helpful.”

The mentors currently in jail also played an important role during the Covid-19 shutdown in San Quentin. In August 2020, the outside counselors began returning to San Quentin to deliver correspondence packages containing therapeutic lessons from the workbook. Every Monday the packages were handed over to the detained counselors to be given to clients in their respective residential units. The completed lessons would be picked up on the following Monday.

According to Higgins, about 85 percent of customers participated in the programming of the correspondence. “They wanted to do something,” he says.

In February of this year, ISUDT started face-to-face events in cohorts based on residential units.

“Consistency and stability were worrying,” says Flanagan of stopping and starting the program during the pandemic. Shortly after the program restarted, the residential unit where Flanagan lives underwent two brief quarantines due to norovirus. He also found out about his cousin’s suicide. “It’s important to me to have the program available,” he says.

Continuation of both medical treatment and personal attention will be essential to Flanagan’s success after his release from prison. And the first few years of the program laid the foundation for real addiction treatment in US prisons. “My vision is to make this program a change that people can come to and have a safe place where they are treated like human,” says Michael Davila, who was once incarcerated and is now program director for MAT / ISUDT. in San Quentin is the program.

Davila recalls an interview with a potential client in which the client got very emotional: “I asked him why he was so emotional – he told me that he felt treated as a person,” he says. “For me, I behaved quite normally. I saw that he needed help and I knew this program could provide it. So I want this program to be a beacon of change for those who want it. I want this to be a bright spot. ”

Juan Moreno Haines is a journalist detained in San Quentin State Prison; Senior Editor at the award-winning San Quentin News; and a member of the Society of Professional Journalists, where he received the 2017 Silver Heart Award for “Voice for the Voiceless”.

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