Majority of prison inmates suffer from addiction, but few receive treatment

Roughly 65% of the nation’s prison and jail inmates have a substance abuse addiction or problem, according to The National Center on Addiction and Substance Abuse at Columbia University, which found that very few inmates receive treatment for the condition while incarcerated.

“For almost every other medical condition, it would be considered cruel and unusual if you did not identify it or offer treatment,” noted Charles Zaylor, DO, during a presentation at OMED 2015 in Orlando.

Dr. Zaylor, a board-certified adult psychiatrist in Leawood, Kansas, has treated inmates for 16 years. During his presentation, he offered advice on treating substance abuse and addiction disorders among prison populations. Here are some highlights:

• Have different physicians treat the patients’ psychiatric and medical disorders. This discourages patients from “splitting staff,” or playing one physician against another, Dr. Zaylor said, and also improves coordination of care.

• Avoid prescribing unnecessary drugs that can be abused.
• Be cognizant of drug-seeking behaviors.
• Understand how your patient conceptualizes drugs and medication – their goal may not be your goal. Patients often request a higher dose of a medication after a few months, Dr. Zaylor said, because they are used to periodically raising the dose on illicit substances they have taken.
• Educate patients on what a normal recovery looks like. Dr. Zaylor said he often has to manage patients’ expectations. For example, those who have difficulty sleeping may expect a prescription drug to allow them to sleep solidly through the night, every night. “I have to explain to patients that the purpose of the drug is to help you get an adequate night’s sleep most of the time,” he said.
• Re-evaluate the diagnosis and treatment plan every six to 12 months. New information can change the way you look at a patient’s diagnosis, so it’s always a good idea to periodically reassess, Dr. Zaylor said.

• Understand that for patients to benefit from drug addiction treatment, they must understand they have a problem and want to change it. “Patients have to be committed to treatment or at least agree that they have a problem,” Dr. Zaylor said.