U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics ------------------------------------------------------ This file is text only without graphics and many of the tables. A Zip archive of the tables in this report in spreadsheet format (.csv) and the full report including tables and graphics in .pdf format are available on BJS's website at: https://www.bjs.gov/index.cfm?ty=pbdetail&iid=5966 ------------------------------------------------------ ****************** Special Report ****************** ************************************************ Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009 ************************************************ Jennifer Bronson, Ph.D., and Jessica Stroop, BJS Statisticians Stephanie Zimmer and Marcus Berzofsky, Dr. P.H., RTI International ************************************************* More than half (58%) of state prisoners and two-thirds (63%) of sentenced jail inmates met the criteria for drug dependence or abuse, according to data collected through the 2007 and 2008- 09 National Inmate Surveys (NIS) (figure 1). In comparison, approximately 5% of the total general population age 18 or older met the criteria for drug dependence or abuse. General population data come from the National Survey of Drug Use and Health (NSDUH) collected from 2007 to 2009 by Substance Abuse and Mental Health Services Administration. Drug dependence and abuse estimates in both the NIS and NSDUH data collections were based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).*** Footnote 1 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision (2000). Washington. DC: American Psychiatric Association.*** ***Footnote 2 The fifth edition of the DSM (DSM-V) was published in May 2013. The DSM-IV was current at time of data collection.*** This report examines patterns of past drug use by different periods (i.e., ever used, at time of offense, month before arrest, and regularly used), demographics, and offense type. Drug data were grouped into eight categories for analysis: marijuana/hashish, cocaine/crack, heroin/opiates, depressants, stimulants, methamphetamine, hallucinogens, and inhalants. ***Footnote 3 Depressants include barbiturates, tranquilizers, and Quaaludes. Stimulants include amphetamine and methamphetamine. Hallucinogens include LSD, PCP, and ecstasy.*** Alcohol and nicotine were excluded from the analysis. Prevalence estimates are presented for inmates who met the DSM-IV criteria for drug dependence or abuse and for those who participated in a drug abuse treatment program. All NIS data were self- reported, and the analyses include state prisoners and sentenced local jail inmates. ************************************************************* ************* Highlights ************* * During 2007-09, an estimated 58% of state prisoners and 63% of sentenced jail inmates met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for drug dependence or abuse. * Among prisoners and jail inmates, prevalence estimates for those who met the criteria for dependence were two to three times higher than for abuse. * The percentage of inmates who met the DSM-IV criteria was higher for those held for property offenses than those held for violent or other public order offenses. * Lifetime drug use among the incarcerated populations was unchanged from 2002 to 2009. * During 2007-09, prisoners (77%) and jail inmates (78%) reported having ever used marijuana/hashish, more than any other drug. * During 2007-09, more females in prison (47%) or jail (60%) used drugs in the month before the current offense than males in prison (38%) or jail (54%). * More non-Hispanic white than non-Hispanic black prisoners regularly used cocaine/crack, heroin/opiates, or methamphetamines. * Among those who met the criteria for drug dependence or abuse, 28% of prisoners and 22% of jail inmates participated in a drug treatment program since admission. ************************************************************* To facilitate comparisons between the inmate and general population, NSDUH data on the general population were standardized twice to (1) match the prison population and (2) match the jail population by sex, race, Hispanic origin, and age. (See Methodology.) In addition, the general population was divided into three groups that were based on self-reported involvement with the criminal justice system in the year prior to the interview: (1) no involvement, (2) under supervision (probation or parole), or (3) arrested. (See Methodology.) This report combined data from the addendums of NIS-1 (2007) and NIS-2 (2008-09). (See Methodology.) The NIS-3 (2011-12) also collected drug use data, but the data were not used because of potential bias. For this reason, the 2007-09 data are the most recent data available on drug use and drug use disorders among inmates. ************************************************************* ********************************************** Measurement of drug dependence and abuse ********************************************** The National Inmate Survey (NIS) included questions to assess the percentage of inmates who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for drug dependence or abuse. Inmates who reported having ever used any drug were asked about their experiences and symptoms related to their drug use in the year prior to admission to the current facility. The DSM-IV criteria are guidelines designed to be used with a patient’s history and sound clinical judgment in order to make a diagnosis. Data presented in this report are based on inmate self-reports and were not validated or confirmed by a trained clinician or clinical interview. (See Methodology.) The DSM-IV defines drug dependence as a maladaptive pattern of drug use leading to clinically significant impairment or distress as manifested by three or more of the following occurring at any time in the same 12-month period: 1.tolerance 2. withdrawal symptoms or drug taken to relieve withdrawal 3. drug taken in larger amounts for longer periods than intended 4. persistent desire or unsuccessful attempts to cut down or control drug use 5. a lot of time is spent obtaining drugs, using them, or recovering from its effects 6. a reduction in or absence from social, occupational, or recreational activities 7. continued use despite adverse consequences. Unlike the criteria for drug dependence, criteria for drug abuse do not include tolerance, withdrawal, or a pattern of compulsive use. Instead, the abuse criteria include only the harmful consequences of repeated use. Abuse is defined in the DSM-IV as a maladaptive pattern of drug use leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring at any time in the same 12-month period: 1. recurrent drug use resulting in a failure to fulfill major role obligations 2. recurrent drug use in which it is physically hazardous 3. recurrent drug-related legal problems 4. continued drug use despite having persistent or recurrent drug-related social problems. For any one drug, a diagnosis of dependence takes precedence over a diagnosis of abuse for the same drug. This means that a person who meets the dependence criteria for a particular drug cannot meet the abuse criteria for that same drug. The DSM-IV states that a diagnosis of drug dependence can be applied to 10 drug classes: alcohol, amphetamine or similarly acting sympathomimetics, cannabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine (PCP) or similarly acting arylcyclohexylamines, and sedatives. The category of drug abuse can apply to all of these drug classes, except nicotine.*** Footnote 4 The DSM-IV uses the term “classes,” which is not the same as the schedule of controlled substances established through the 1970 Controlled Substance Act (P.L. 91-513).*** A diagnosis of drug dependence or abuse should be drug- specific (e.g., cocaine dependence or heroin abuse) and not generally made based on drug use in the past year as a whole. However, NIS data do not permit an analysis of dependence or abuse symptoms by individual drug type. As such, dependence and abuse data presented in this report are not drug- specific. ************************************************************* ********************************* Drug dependence and abuse ********************************* During 2007-09, more than half of state prisoners and two-thirds of sentenced jail inmates met the DSM-IV criteria for drug dependence or abuse *********************************************** About 58% of state prisoners and 63% of sentenced jail inmates during 2007-09 met the DSM-IV criteria for drug dependence or abuse for any drug (table 1). Among state prisoners, 42% met the criteria for drug dependence and 17% met the criteria for abuse. The percentage of state prisoners who met the criteria for dependence was the same as those who did not meet the criteria for either dependence or abuse (42% each). Sentenced jail inmates were about three times as likely to have met the criteria for drug dependence (47%) than those who met the criteria for abuse (16%). For sentenced jail inmates, the percentage of those who met the criteria for dependence (47%) was higher than those who did not meet the criteria for either dependence or abuse (37%). Female inmates were more likely than male inmates to have met the DSM-IV criteria for drug dependence or abuse *********************************************** Approximately 7 in 10 females in state prison (69%) or jail (72%) met the DSM-IV criteria for dependence or abuse, compared to about 6 in 10 males in prison (57%) or jail (62%) (table 2). A larger percentage of non-Hispanic white state prisoners (62%) and sentenced jail inmates (72%) met the criteria for dependence or abuse than non-Hispanic black inmates in prison (55%) or jail (57%). Hispanic inmates (58% in prison and 55% in jail) were also less likely than white inmates to have met the criteria. Approximately 26% of prisoners and 40% of sentenced jail inmates age 55 or older met the criteria for dependence or abuse. These numbers were less than the 64% of prisoners and 62% of sentenced jail inmates ages 18 to 24 who met the same criteria. Inmates incarcerated for a property offense were more likely to have met the criteria for dependence or abuse than inmates incarcerated for other offenses *********************************************** About 54% of state prisoners and 61% of sentenced jail inmates incarcerated for violent offenses met the DSM-IV criteria for drug dependence or abuse. This was lower than the percentage of prisoners and jail inmates incarcerated for property (68% of prisoners and 72% of jail inmates) or drug (67% and 74%) offenses. Among prisoners who met the criteria for drug dependence or abuse, there was no difference in the percentage incarcerated for violent offenses (54%), DWI/DUI offenses (55%), or other public order offenses (55%). Among jail inmates, 45% of those incarcerated for DWI/DUI and 51% for public order offenses met the criteria. State prisoners were 12 times more likely than adults in the general population to have met the criteria for dependence or abuse *********************************************** The NSDUH general population data included adults age 18 or older and were standardized to match the prison population by sex, race, Hispanic origin, and age. The general population was divided into three groups based on their self-reported involvement in the criminal justice system during the year prior to the interview: (1) no involvement, (2) under supervision (probation or parole) or (3) arrested. A total general population was also included, which combined all three groups into one category. The percentage of state prisoners who met the DSM-IV criteria for drug dependence or abuse (58%) was 12 times higher than adults in the total general population (5%) and 14 times higher than the general population (4%) that was not criminally involved with the justice system (table 3). Adults in the general population who had been on probation or parole (12%) or who had been arrested in the past 12 months (19%) were more likely to have met the criteria for drug dependence or abuse than their noncriminally involved counterparts (4%). Similar to the pattern observed among prisoners, a larger percentage of people in each general population group met the criteria for drug dependence than abuse. Among persons not involved in the criminal justice system, 2% met the criteria for drug dependence and 1% met the criteria for drug abuse. A larger percentage of adults on probation or parole met the criteria for drug dependence (10%) than abuse (3%). This pattern was similar for adults who were arrested: 15% met the criteria for drug dependence compared to 5% for abuse. Jail inmates were more likely to have met the criteria for dependence or abuse than those in the general population who had been arrested *********************************************** Approximately two-thirds (63%) of the sentenced jail population met the DSM-IV criteria for either drug dependence or abuse (table 4). This was more than 10 times the percentage of adults in the standardized general population (6%), and almost 15 times the percentage of the noncriminally involved standardized general population who met the criteria for drug dependence or abuse (4%). The percentage of sentenced jail inmates who met the criteria for drug dependence (47%) was about three times larger than those who met the criteria for drug abuse (16%). This pattern was the same for the general population on probation or parole (11% for drug dependence and 3% for abuse) and for those who were arrested in the past 12 months (16% drug dependence and 5% for abuse). *********************************************** Trends in lifetime and regular use of drugs by state prisoners and jail inmates *********************************************** Overall drug use reported by inmates was unchanged from past surveys *********************************************** Lifetime use and regular use of drugs by state prisoners and sentenced jail inmates remained relatively stable. During 2007- 09, an estimated 81% of persons in prisons and 84% of those in jail reported ever using any drug in their lifetime (table 5). These percentages were virtually unchanged from the 83% of prisoners (based on BJS’s 2004 Survey of Inmates in State Correctional Facilities) and 85% of sentenced jail inmates (based on BJS’s 2002 Survey of Inmates in Local Jails) reported ever using drugs. Since the 2002 and 2004 surveys, regular use of drugs slightly increased among prisoners and jail inmates during 2007-09. Regular use was defined as having ever used any drug once a week or more for at least a month. In 2004, 69% of prisoners regularly used drugs and in 2002, 71% of jail inmates regularly used drugs. These numbers were similar to 72% of prisoners and 75% of jail inmates who regularly used drugs during 2007-09. More state prisoners and jail inmates reported they had ever used marijuana/hashish than any other drug *********************************************** Among state prisoners, marijuana/hashish was the most often reported drug type (77%) during 2007-09, followed by cocaine/crack (47%). In 2004, the percentage of prisoners who had ever used marijuana/hashish (78%) and cocaine/crack (47%) were nearly the same. Nearly 42% of prisoners during 2007-09 said they had ever used hallucinogens, which was up from the 33% who reported its use in 2004. Likewise, the percentage of state prisoners who had ever used depressants increased from 21% in 2004 to 30% during 2007- 09. Regular use of depressants among state prisoners almost doubled between 2004 and 2007-09, increasing from 10% to 18%. Regular use of hallucinogens prior to incarceration also increased, from 13% in 2004 to 22% during 2007-09. During 2007-09, the percentages of sentenced jail inmates who had ever used or regularly used drugs were similar to prisoners. Marijuana/hashish (78%) and cocaine/crack (52%) were the most frequently used drugs that jail inmates had ever used. This pattern did not change from 2002. Between 2002 and 2007-09, a larger percentage of jail inmates reported ever using heroin/opiates (21% in 2002 and 28% during 2007-09), depressants (22% and 34%), stimulants (29% and 34%), and hallucinogens (34% and 46%). An estimated 75% of sentenced jail inmates reported regular use of any drug during 2007-09, compared to 70% in 2002. The percentage of jail inmates who regularly used a drug increased across all but one drug type from 2002 to 2007-09. About 39% of jail inmates during 2007-09 reported regular use of cocaine/crack, compared to 32% of those in 2002. Regular use of depressants during 2007-09 by jail inmates (21%) was twice that of the percentage who reported the same in 2002 (11%). The percentage of jail inmates who reported regular use of heroin/opiates increased from 12% in 2002 to 19% during 2007-09, stimulants increased from 18% to 24%, and hallucinogens from 14% to 23%. *********************************************** Patterns of drug use at time of the offense *********************************************** 4 in 10 prisoners and jail inmates used drugs at the time of the offense for which they were currently incarcerated *********************************************** During 2007-09, about 4 in 10 state prisoners (42%) and sentenced jail inmates (37%) said they used drugs at the time of the offense for which they were currently incarcerated (table 6). Among prisoners, 22% reported marijuana/hashish use at time of the offense, 16% reported cocaine/crack use, 11% reported stimulant use, and 7% reported heroin/opiate use. Among sentenced jail inmates, 19% reported using marijuana/hashish at time of the offense, 13% reported cocaine/crack use, and 8% reported stimulant and heroin/opiate use. About 4 in 10 state prisoners and sentenced jail inmates who were incarcerated for property offenses committed the crime to get money for drugs or to obtain drugs *********************************************** About 21% each of state prisoners and sentenced jail inmates said their most serious current offense was committed to get money for drugs or to obtain drugs (table 7). A larger percentage of prisoners (39%) and jail inmates (37%) held for property offenses said they committed the crime for money for drugs or drugs than other offense types. Nearly a third of drug offenders (30% of state prisoners and 29% of jail inmates) said they committed the offense to get drugs or money for drugs. Approximately 1 in 6 state prisoners (15%) and jail inmates (14%) who committed violent offenses said they did so to get money for drugs or to obtain drugs. *********************************************** Drug use by demographics and offense *********************************************** Among state prisoners, females, whites, and those age 54 or younger were more likely than other persons to have used drugs in the month before the offense *********************************************** About 39% of state prisoners during 2007-09 used drugs in the month before the offense, and 42% used drugs at the time of offense (table 8). For both 2004 and 2007-09, reference periods, female prisoners were more likely to have used drugs than their male counterparts. An estimated 47% of females used drugs in the month before and 49% at the time of the offense, compared to 38% of males who used drugs in the month before and 41% at time of the offense. Black and Hispanic prisoners were less likely than white prisoners to report drug use in the month before or at the time of the offense. The percentage of prisoners who reported drug use in the month before the offense declined with age. About 47% of prisoners ages 18 to 24 used drugs in the month before the offense, compared to 36% of those ages 45 to 54 and 16% of those 55 or older. Drug use at the time of the offense varied less across age groups, with about 42% to 45% of prisoners age 54 or younger reporting use. However, prisoners age 55 or older were significantly less likely to have used drugs at time of the offense (19%) than prisoners of other age groups. State prisoners incarcerated for property or drug offenses were more likely to have used drugs than those who committed violent offenses *********************************************** During 2007-09, state prisoners whose most serious current offense was a violent offense were less likely to have used drugs in the month before the offense (34%) than those incarcerated for a property crime (47%), drug offense (47%), or public order offense (44%). Four in 10 (40%) prisoners incarcerated for violent crimes said they used a drug at time of the offense. This was lower than the percentage of prisoners incarcerated for a property offense (50%) or a drug offense (50%) but more than the percentage incarcerated for a DWI/DUI (28%) or other public order offense (29%). Female jail inmates were more likely than male inmates to have used drugs in the month before the offense or at the time of the offense *********************************************** More than half (54%) of sentenced jail inmates during 2007-09 used a drug in the month before the offense. About 37% used a drug at the time of the offense. Much like the demographic profile of state prisoners, a larger percentage of females than males in jail reported drug use in the month before the offense or at the time of the offense. Sentenced jail inmates who were black, Hispanic, or of other races were less likely than white inmates to report drug use in the month before or at the time of the offense. About 61% of sentenced jail inmates ages 18 to 24 used drugs in the month before their offense, and this percentage decreased among older groups. In comparison, fewer jail inmates ages 18 to 24 used drugs at the time of the offense (36%) than those ages 25 to 34 (41%) and 35 to 44 (40%). More than half of sentenced jail inmates incarcerated for a drug crime used drugs at the time of the offense *********************************************** When assessed by offense type, sentenced jail inmates had a similar pattern of drug use in the month before the offense. About 2 in 3 jail inmates incarcerated for property offenses (63%) or drug offenses (67%) used drugs in the month before the offense. These percentages were higher than that of jail inmates (54%) who were incarcerated for a violent offense and used drugs in the month before arrest. Jail inmates incarcerated for DWI/DUI (24%) or other public order offenses (43%) were the least likely to have used drugs in the month before the offense. A smaller percentage of inmates incarcerated for violent offenses (37%) than for property (46%) or drug (51%) offenses used drugs at the time of the offense. *********************************************** Regular use of cocaine/crack, methamphetamine, or heroin/opiates by demographics *********************************************** Patterns of regular drug use differed by race and Hispanic origin. White inmates in prison or jail were more likely than black or Hispanic inmates to have regularly used any drug. Black prisoners were the least likely to have regularly used cocaine/crack (28%), compared to whites (42%) and Hispanics (31%) (figure 2). Among jail inmates, 31% of blacks, 47% of whites, and 29% of Hispanics regularly used cocaine/crack (figure 3). Black inmates were the least likely among prisoners and jail inmates to report regular use of methamphetamine or heroin/opiates. Cocaine/crack *************** During 2007-09, regular use of cocaine/crack was highest among females, whites, inmates ages 35 to 44, and property offenders *********************************************** Almost half of female state prisoners (49%) and sentenced jail inmates (48%) regularly used cocaine/crack (table 9). Among male inmates, 31% of those in prison and 36% of those in jail regularly used cocaine/crack. Regular use of cocaine/crack was highest among inmates ages 45 to 54 (42% of state prisoners and 52% of jail inmates). A quarter of prisoners (26%) and jail inmates (24%) ages 18 to 24 said they regularly used cocaine/crack. A larger percentage of state prisoners incarcerated for property (45%) or drug (37%) offenses than violent offenses (29%) said they regularly used cocaine/crack. Among sentenced jail inmates, 48% of those incarcerated for property offenses, 43% for drug offenses, and 34% for violent offenses reported regular use of cocaine/crack during 2002-09. Methamphetamine ***************** Female inmates were more likely than male inmates to have regularly used methamphetamine during 2007-09 *********************************************** Among both prisoners and jail inmates, a larger percentage of females (31% for prison and 26% for jail) than males (17% each) reported regular use of methamphetamine (table 10). About 19% of prisoners in each age group age 54 or younger reported regular use of methamphetamine, compared to 8% of prisoners age 55 or older. Jail inmates ages 25 to 44 (21%) were more likely to have regularly used methamphetamine than those ages 18 to 24 (14%). A higher percentage of white (34%) than black (2%) prisoners regularly used methamphetamine. Among jail inmates, 31% of whites and 3% of blacks regularly used methamphetamine. Among Hispanics in state prison or jail, about 19% of each population regularly used methamphetamine. More state prisoners incarcerated for property offenses (28%) than violent offenses (14%) reported regular use of methamphetamine. Among sentenced jail inmates, a larger percentage of those incarcerated for property (24%) or drug (23%) offenses than violent offenses (16%) reported regular use of methamphetamine. Heroin/opiates ***************** Regular use of heroin/opiates was lowest among black prisoners and jail inmates during 2007-09 *********************************************** About 1 in 4 females in state prison (22%) or jail (25%) reported regular use of heroin/opiates, compared to about 1 in 6 males in prison (15%) or jail (17%) (table 11). Twenty-two percent of both prisoners and jail inmates ages 45 to 54 reported they regularly used heroin/opiates. These percentages were higher than those ages 18 to 24 who said they regularly used heroin/opiates among prisoners (12%) and jail inmates (14%). Three times more whites (25%) than blacks (8%) in prison regularly used heroin/opiates. Almost four times more whites (30%) than blacks (8%) in jail regularly used heroin/opiates. Hispanics in prison (16%) and jail (12%) were also less likely than white inmates to have regularly used heroin/opiates. Prisoners (25%) and jail inmates (24%) incarcerated for property offenses had higher rates of regular use of heroin/opiates than those incarcerated for violent offenses (13% for prisoners and 15% for jail inmates). Seventeen percent of prisoners and 23% of jail inmates incarcerated for drug offenses said they regularly used heroin/opiates. *********************************************** Estimates of lifetime and regular use of drugs among adults in the general population *********************************************** Little to no change occurred in the percentage of adults in the general population who had ever used or regularly used drugs between 2002-04 and 2007-09 *********************************************** During the 3-year aggregate period from 2002 to 2004, about half (48%) of adults in the general population said they had ever used drugs (figure 4). Nearly the same percentage of adults (49%) in the general population reported ever using any drug during 2007- 09. Among adults in the general population who had ever used drugs, there was little to no difference by drug type between reference periods. In both periods, about 44% of adults in the general population said they had ever used marijuana/hashish, compared to 16% who ever used cocaine/crack, 16% who ever used hallucinogens, and 15% who ever used heroin/opiates. Methamphetamine was the least reported, with 5% of adults in the general population who said they had ever used the drug. There was virtually no variation observed between 2002-04 and 2007-09 in the percentage of adults in the general population who reported regular use of drugs (figure 5). For the adult general population, regular use was defined as use of any drug at least once in the past month prior to the interview. During 2007-09, fewer than 1 in 10 (8%) adults in the general population reported regular use of drugs. Month-before drug use among prisoners was three times higher than the general population *********************************************** Drug use for the month-before reference period was defined differently for the general population and inmates. For the general population, it was the percentage who reported drug use in the month before the interview. For both prisoners and jail inmates, it was the percentage who said they used drugs in the month before their arrest. During 2007-09, the percentage of prisoners (39%) who reported drug use in the month before arrest was more than three times higher than the standardized adult general population (12%) and five times higher than the unstandardized adult general population (8%) (table 12). Twenty-four percent of the general population on probation or parole and 32% of those who were arrested in the past year reported drug use in the past month. For almost every drug type, prisoners were significantly more likely than adults in the general population to have used it in the month before the arrest or interview. However, the exceptions were adults in the general population who were arrested in the past year. They were as likely as prisoners to have used marijuana/hashish (27%) and heroin/opiates (7%) in the month before the interview. Among prisoners and adults in the general population, marijuana/hashish was reported as the most used drug in the month before the arrest or interview *********************************************** State prisoners (28%) and adults in the general population (10%) reported more past month use of marijuana/hashish than any other drug. However, prisoners reported cocaine/crack (15%) as the second most used drug in the month before. Adults in the general population reported heroin/opiates (2%) as the second most reported drug used in the month before. The use of stimulants in the month before was higher among prisoners (10%) than adults in the general population (0.4%) and those with no past year criminal justice involvement (0.4%). Stimulant use was also higher among prisoners than among adults in the general population on probation or parole (2%) and those who had been arrested (2%). Sentenced jail inmates were more likely than the general population to have used drugs in the prior month *********************************************** During 2007-09, more than half (55%) of sentenced jail inmates used drugs in the month before the arrest (table 13). This compares to 12% of adults in the standardized general population with no criminal justice involvement, 14% of adults in the standardized general population, 27% of those on probation or parole, and 35% of those who had been arrested in the past year. Across all drug types, sentenced jail inmates were more likely than adults in the general population to have used the drug in the month prior to their interview. This pattern also held for each subgroup of adults in the general population by criminal justice involvement. Compared to the standardized total general population, sentenced jail inmates were more likely to have reported past month stimulant use (12% for jail inmates and 1% for the general population), to have used cocaine/crack (21% and 1%), and to have used depressants (12% and 1%). *********************************************** Participation in drug treatment programs *********************************************** Fewer than a third of inmates who met the criteria for drug dependence or abuse received drug treatment or participated in a program *********************************************** Among inmates who met the DSM-IV criteria for drug dependence or abuse, 28% of prisoners and 22% of jail inmates said they received drug treatment or participated in a program since admission to the current facility (table 14). However, inmates may have participated in or received more than one type of treatment program. Nineteen percent of those in prison said they participated in a self-help group or peer counseling, 15% were in a drug education program, 10% were placed in a residential facility or unit, and 6% received drug-related counseling by a professional. In comparison, about 12% of sentenced jail inmates who met the DSM-IV criteria participated in a self-help group or peer counseling, 8% were in a drug education program, 8% were placed in a residential facility or unit, and 6% received drug-related counseling by a professional. Prisoner and jail inmate participation in a drug treatment program did not differ by time since arrival to the current facility or time until release *********************************************** Prisoner and jail inmate participation in a drug treatment program was assessed by time spent in the current facility since arrival and expected time left until release. Among prisoners who met the criteria for dependence or abuse and had been in the current facility for 6 months or less, 60% received or participated in a drug treatment program during 2007-09 (table 15). Of those prisoners who met the criteria for dependence or abuse and had 12 months or less before release, 64% said they had participated in a drug treatment program. Among sentenced jail inmates who met the criteria for dependence or abuse and had been in the current facility for 6 months or less, 63% participated in a drug treatment program. The same percentage of jail inmates who met the criteria and had 12 months or less until release participated in a drug treatment program (63%). More inmates who met the criteria for dependence or abuse participated in a drug treatment program than adults in the general population *********************************************** An estimated 11% of adults in the general population who met the DSM-IV criteria for drug dependence or abuse received or participated in a drug treatment program in the past 12 months prior to the interview (table 16). (See Methodology.) Among adults in the general population who met the criteria for dependence or abuse, criminal justice involvement increased the likelihood of past year participation in a drug treatment program. When standardized to match the prison population by sex, race, Hispanic origin, and age, about 8% of adults in the general population who met the criteria for dependence or abuse and had no past year criminal justice involvement received or participated in a drug treatment program in the past year. In comparison, 35% of the probation or parole population and 30% of those arrested in the past year were in a drug treatment program. Adults in the general population who met the criteria for dependence or abuse and who participated in a drug treatment program in the past year reported more often that it was a self- help group compared to other treatment program type. When standardized to match the prison population by sex, race, Hispanic origin, and age, 30% of those on probation or parole, 23% of those who were arrested, 10% of adults in the total general population, and 5% of noncriminally justice-involved adults in the past year reported they had attended a self-help group. Of those adults who met the criteria for dependence or abuse and participated in a drug treatment program in the past year, 5% of those on probation or parole and 4% of those who were arrested reported that the location of this drug treatment program was in a prison or jail. ************** Methodology ************** *********************************************** National Inmate Surveys, 2007 and 2008-09 *********************************************** Estimates produced for this report are based on survey responses from the National Inmate Survey, 2007 (NIS-1) and the National Inmate Survey, 2008-09 (NIS-2). The NIS-1 was conducted in 127 state prisons, 14 federal prisons, and 282 local jails between April and December 2007. The NIS-2 was conducted in 148 state prisons, 19 federal prisons, 286 local jails, and 10 special facilities (military, Indian country, and Immigration and Customs Enforcement (ICE)) between October 2008 and December 2009. RTI International, under a cooperative agreement with the Bureau of Justice Statistics (BJS), collected the data for both collections. The NIS-1 and NIS-2 administered two questionnaires to inmates: (1) a survey about sexual victimization while incarcerated and (2) a survey about prior drug and alcohol use, drug dependence and abuse symptoms, and treatment for drug dependence or abuse. Inmates were randomly assigned to receive one of the two questionnaires, so that at the time of the interview, the content of the survey remained unknown to facility staff and the interviewers. A total of 71,571 inmates participated in NIS-1 and 81,566 inmates participated in NIS-2 receiving either the sexual victimization survey or the randomly assigned companion survey. In NIS-1, the surveys were administered to 22,943 inmates in state prisons, 3,214 federal prisons, and 45,414 inmates in jails. In NIS-2, the surveys were administered to 28,749 state prisoners, 3,280 federal prisoners, 48,066 inmates in jails, and 1,471 inmates in special facilities. The interviews, which averaged 30 minutes, used computer-assisted personal interviewing (CAPI) and audio computer-assisted self- interviewing (ACASI) data collection methods. In both surveys, interviewers conducted a personal interview using CAPI to obtain background information and date of administration. For the remainder of the interview, inmates interacted with a computer administered questionnaire using a touchscreen and synchronized audio instructions delivered via headphones. Respondents completed the ACASI portion of the interview in private, with the interviewer either leaving the room or moving away from the computer. ACASI administration helped to elicit more candid responses on sensitive subjects and behaviors, eliminated literacy issues, and protected respondents’ privacy. While underreporting of behaviors may exist, the relative extent is unknown. A shorter paper questionnaire (PAPI) was made available for inmates who were unable to come to the private interviewing room or interact with the computer. The paper form was completed by 530 NIS-1 and 496 NIS-2 prisoners (or 2.0% for NIS-1 and 1.5% for NIS-2 prisoner interviews) and 233 NIS-1 and 226 NIS-2 jail inmates (0.5% of all jail inmate interviews in both NIS-1 and NIS-2). Inmates who completed the PAPI were not asked about their prior drug and alcohol use or treatment for drug abuse. Additional information on the methodology for sample selection of facilities and inmates can be found in Sexual Victimization in Local Jails Reported by Inmates, 2007 (NCJ 221946, BJS web, June 2008), Sexual Victimization in State and Federal Prisons Reported by Inmates, 2007 (NCJ 219414, BJS web, December 2007), and Sexual Victimization in Prisons and Jails Reported by Inmates, 2008-09 (NCJ 231169, BJS web, August 2010). In this report, the analysis of past drug use, drug dependence and abuse symptoms, and treatment was restricted to adult state prisoners or jail inmates. Inmates in federal prisons, military, Indian country, or ICE facilities were excluded from this report. *********************************************** Measurement of prior drug use and drug abuse treatment *********************************************** Prior drug use, drug dependence and abuse symptoms, and treatment modules were administered to participating inmates in the NIS-1 and NIS-2 for one of two reasons: 1. To ensure the survey length was similar for all participating prisoners and jail inmates regardless of whether they had experienced a victimization. 2. As part of the alternative survey, the drug use questions consisted of an initial screener asking about each type of drug a prisoner or jail inmate may have used in their lifetime prior to incarceration. For each drug that an inmate had used, follow-up questions were asked about the frequency of use and periods in which the inmate used the drug (e.g., month prior to the offense, at the time of the offense). Questions on past drug use consisted of an initial screener asking about eight types of drugs a prisoner or jail inmate may have ever used in their lifetime: marijuana/hashish, cocaine/crack, heroin/opiates, depressants, stimulants, methamphetamine, hallucinogens, and inhalants. For each drug that an inmate said they had ever used, follow-up questions were asked about the frequency in which each drug was used and periods in which the inmate used the drug (e.g., month prior to the offense or at the time of the offense). Prisoners and jail inmates who met the drug dependence or abuse criteria were asked if they had attended any kind of drug treatment program since admission to the current facility. Drug treatment programs were defined as (1) spending time in a special facility or unit, (2) counseling with a trained professional while not living in a special facility or unit, (3) spending up to 72 hours in a detoxification unit to dry out, (4) receiving a maintenance drug to cut the high or to make you sick (e.g., methadone), (5) self-help or peer group counseling (e.g., Narcotics Anonymous), or (6) an education or awareness program that explained the problems with drug use. Among prisoners and jail inmates who received the sexual victimization survey (90% of inmates surveyed in NIS-1 and 95% of inmates surveyed in NIS-2), inmates received the prior drug use, dependence and abuse symptoms, and treatment components only if they completed the sexual victimization modules in less than 30 minutes. Based on this criterion, 38,008 state prisoners received the past drug use and drug abuse treatment modules (80% of sexual victimization survey prison respondents). Among jail respondents, 73,396 inmates received the past drug use and drug abuse treatment modules (86% of jail sexual victimization survey respondents). A total of 3,432 state prisoners and 6,577 jail inmates were randomized to the alternative survey. This constituted 10% of NIS-1 respondents and 5% of NIS-2 respondents. These prisoners and jail inmates received the full set of past drug use, dependence and abuse symptoms, and treatment modules. *********************************************** Measurement of drug dependence and abuse *********************************************** To determine if a prisoner or jail inmate met the criteria for drug dependence or abuse, a series of questions was modeled after the DSM-IV criteria and included on the NIS surveys. The following NIS questions were used to assess drug dependence with the corresponding DSM-IV criteria category in parentheses. A positive response to three or more of the items indicated that a prisoner or jail inmate likely met the DSM-IV criteria for dependence. During the year before you were admitted to the current facility-- 1. Did your usual amount of drugs have less effect on you than it once did or did you have to use more to get the effect you wanted? (tolerance) 2. Did you experience some of the bad after-effects of using drugs after cutting down or stopping your drug use—like shaking, feeling nervous or anxious, sick to your stomach, restless, sweating, or having trouble sleeping or fits or seizures, or see, feel, or hear things that weren’t really there? (withdrawal-a) 3. Did you ever keep using drugs to get over any of the bad after-effects of a drug or to keep from having bad after- effects? (withdrawal-b) 4. Did you often use a drug in larger amounts or for longer periods than you meant to? (compulsive use) 5. Did you more than once want to cut down on your drug use or try to cut down on your drug use but found you couldn’t do it? (impaired control) 6. Did you spend a lot of time getting drugs, using them, or getting over the bad after-effects? (time spent) 7. Did you give up activities that you were interested in or that were important to you in favor of using drugs like— work, school, hobbies, or associating with family and friends? (neglect of activities) 8. Did you continue to use drugs even though it was causing emotional or psychological problems? (continued use despite problems-a) 9. Did you continue to use drugs even though it was causing physical health or medical problems? (continued use despite problems-b) For each symptom, the percentage of prisoners reporting they experienced symptoms ranged from 31% (withdrawal) to 40% (continued use despite problems) (table 17). Approximately 45% of prisoners had no dependence symptoms, 8% had one, and 47% had two or more. For jail inmates, the percentage who experienced symptoms ranged from 37% (withdrawal, time spent obtaining and using, and neglect of activities) to 46% (continued use despite problems). Thirty-nine percent of jail inmates had no dependence symptoms, 8% had one, and 53% had two or more. The following NIS questions were used to measure if a person met the drug abuse criteria. The corresponding DSM-IV criteria category follows in parentheses. A positive response to one or more of the items, in conjunction with fewer than three positive responses to the dependence items, indicated that a prisoner or jail inmate was likely to have met the criteria for drug abuse. During the year before you were admitted to the current this facility-- 1. Did you lose a job because of your drug use? (failure to fulfill obligations-a) 2. Did you have job or school trouble because of your drug use, like missing too much work, not doing your work well, being demoted at work, or dropping out of school? (failure to fulfill obligations-b) 3. Did using drugs or being sick from using drugs keep you from doing work, going to school, or caring for children? (failure to fulfill obligations-c) 4. Did you get into situations while using drugs or just after using drugs that increased your chances of getting hurt— like driving a car or other vehicle, swimming, using machinery, or walking in a dangerous area or around traffic? (use in hazardous situations) 5. Did you get arrested or held at a police station because of your drug use? (legal problems) 6. Did you have arguments with your spouse, boyfriend or girlfriend, family, or friends while under the influence of a drug? (social problems-a) 7. Did you get into a physical fight while under the influence of a drug? (social problems-b) 8. Did you continue to use drugs even though it was causing problems with family, friends, or work?” (social problems-c) For each abuse symptom, the percentage of prisoners reporting they experienced symptoms ranged from 28% (legal problems) to 52% (social problems) (table 18). Approximately 43% of prisoners had no abuse symptoms, 14% had one, and 43% had two or more. Among jail inmates, the percentage who met each abuse symptoms ranged from 31% (use in hazardous situations) to 56% (social problems). Thirty-eight percent had no symptoms, 14% had one, and 48% had two or more. ***************************** Nonresponse bias analysis ***************************** Bias occurs when the estimated prevalence of an outcome is different from the actual prevalence of the outcome for a given facility. One potential source of bias is nonresponse. A nonresponse bias analysis was conducted to determine if prisoners or jail inmates who did not receive the past drug use, alcohol, and drug abuse treatment modules were different from those who did. Among the sexual victimization survey respondents, there were two potential sources for nonresponse bias. First, due to time limitations in the survey, about 20% of ACASI state prison respondents and 16% of ACASI jail respondents did not receive the drug, alcohol, and treatment modules. These respondents were more likely to have indicated a sexual victimization. While these percentages were large, it was determined to be possible to adjust for this potential bias through a post-survey weight adjustment (see section on Weighting and nonresponse adjustments). Second, prisoners or jail inmates who took the survey via PAPI did not receive the past drug use, dependence, or abuse symptoms, or treatment modules. The sexual assault survey PAPI respondents were found to have a higher prevalence of sexual victimization. Given that the PAPI respondents made up 1.8% of prison respondents and 0.5% of jail respondents across the combined survey years, it was determined that a weight adjustment could reduce the potential bias due to PAPI respondents not being asked the past drug use and drug abuse items. For the alternative survey, since all respondents completed the survey via ACASI, there was no potential for bias due to the mode of the interview. *********************************************** Weighting and nonresponse adjustments *********************************************** Responses from interviewed prisoners and jail inmates were weighted to produce national-level estimates. Each interviewed inmate was assigned an initial weight corresponding to the inverse of the probability of selection within each sampled facility. A series of adjustment factors was applied to the initial weight to minimize potential bias due to nonresponse and to provide national estimates: 1. The adjustment of overall survey nonresponse is described in detail in Sexual Victimization in Local Jails Reported by Inmates, 2007 (NCJ 221946, BJS web, June 2008), Sexual Victimization in State and Federal Prisons Reported by Inmates, 2007 (NCJ 219414, BJS web, December 2007), and Sexual Victimization in Prisons and Jails Reported by Inmates, 2008-09 (NCJ 231169, BJS web, August 2010). 2. A second weighting adjustment was conducted to account for the potential bias due to survey mode nonresponse among the sexual victimization survey respondents. Bias could result if the PAPI respondents were different from the ACASI respondents. Because PAPI respondents received only the sexual victimization survey, this adjustment was not applied to alternative survey respondents. The adjustment for mode nonresponse included a calibration of the weights so that the weight from a PAPI respondent was assigned to an ACASI respondent with similar characteristics. Since both ACASI and PAPI respondents provided demographic and criminal history information, these data were used in weight adjustment. For each inmate, these adjustments were based on a generalized exponential model developed by Folsom and Singh (2002), and applied to the sexual victimization survey respondents. ***Footnote 5 Folsom, Jr., R.E., and Singh, A.C. (2002). The generalized exponential model for sampling weight calibration for extreme values, nonresponse, and poststratification. Proceedings of the American Statistical Association, Survey Research Methods Section, pp. 598–603.*** 3. A third adjustment corrected for module nonresponse. Sexual victimization survey respondents who did not complete the sexual victimization modules within 30 minutes and, therefore, did not receive the past drug use or drug abuse treatment modules were considered nonrespondents. Because alternative survey respondents did not have a similar time constraint, this adjustment was not applied to inmates randomized to the alternative survey. The module nonresponse adjustment included a calibration of the weights so that the weight from a past drug use and drug abuse treatment module nonrespondent was assigned to a responding prisoner or jail inmate with similar characteristics. The adjustment used data from modules that both groups completed, including demographic, criminal history, sexual victimization, and interview debriefing characteristics. This adjustment ensured that the estimates accurately reflected the full sample, rather than only the prisoners and jail inmates who responded to the past drug use or drug abuse treatment modules. For each inmate, these adjustments were based on a generalized exponential model and applied to the sexual victimization survey respondents. The survey mode and module nonresponse adjustments maintained the control totals designed to provide national-level estimates for the number of prisoners and jail inmates age 18 or older who were held in jails at midyear 2007 for NIS-1 and 2009 for NIS-2, or in prison at yearend in 2007 and 2009.***Footnote 6 In NIS-1 the state inmate population was not benchmarked to the National Prisoner Statistics.*** The totals estimated the number of prisoners and jail inmates by sex during the survey period. These totals came from BJS’s Annual Survey of Jails and National Prisoner Statistics Program for local jail and state prison respondents. In 2007, the national estimates for local jails (with an average daily population of six or more inmates) were 673,005 males and 99,810 females. In 2009, the national estimates for state prisons were 1,178,916 adult males and 88,518 adult females. For jails with an average daily population of six or more inmates, estimates included 678,136 adult males and 99,096 adult females. 4. A fourth adjustment corrected survey weights to account for the combining of multiple survey years to allow survey totals to represent the average number of prisoners or jail inmates across the survey years included in the analytic file. The weight adjustment was produced by dividing the mode nonresponse adjusted weights by the number of survey years being combined—in this case 2 years. 5. A final adjustment was applied to combine data from the sexual victimization survey and the alternative survey. For this adjustment, the weight for each responding prisoner or jail inmate was multiplied by the probability of receiving the survey type received. In NIS-1 the survey nonresponse and mode nonresponse adjusted weight for the ACASI respondents were multiplied by 0.90 for the sexual victimization survey and by 0.10 for respondents to the alternative survey. In NIS-2 the survey nonresponse and mode nonresponse adjusted weight for the ACASI respondents were multiplied by 0.95 in the sexual victimization survey and 0.05 for respondents to the alternative survey. *********************************************** Standard errors and tests of significance *********************************************** As with any survey, the NIS estimates are subject to error arising from their basis on a sample rather than a complete enumeration of the population of adult inmates in prisons and jails. For past drug use, dependence and abuse symptoms, and treatment outcomes, the estimated sampling error varies by the size of the estimate, by the number of completed interviews, and by the intracluster correlation of the outcome within facilities. A common way to express this sampling variability is to construct a 95% confidence interval around each survey estimate. Typically, multiplying the standard error by 1.96 and then adding or subtracting the result from the estimate produces the confidence interval. This interval expresses the range of values that could result among 95% of the different samples that could be drawn. To facilitate the analysis, differences in the estimates of sexual victimization for subgroups in these tables have been tested and notated for significance at the 95% confidence level. For example, the difference in the percentage of state prisoners who reported ever using heroin/opiates during 2007-09 compared to state prisoners and jail inmates in 2004 is statistically significant at the 95% confidence level (table 1). In all tables providing detailed comparisons, statistically significant differences at the 95% level of confidence or greater have been designated with two asterisks (**) when comparing two different population types (e.g., persons in prison and persons in the general population). *********************************************** Comparing NIS estimates to prior prisoner and jail inmate surveys *********************************************** In analyzing past drug use, dependence and abuse symptoms, and treatment among jail inmates, the analysis was restricted to sentenced jail inmates. The jail population was restricted to be comparable to the Survey of Inmates in Local Jail surveys. The prior survey was restricted to sentenced jail inmates to ensure the respondent would meet the minimum time in the facility to be eligible for the survey, and also to increase the likelihood that the jail respondents would be eligible to have access to treatment services while in jail. The NIS estimates on drug dependence and abuse and drug abuse treatment were not compared to prior inmate surveys (e.g., 2004 Survey of Inmates in State Correctional Facilities and 2002 Survey of Inmates in Local Jails) for two reasons. First, the NIS used a different data collection mode from the prior inmate surveys. The NIS used ACASI for the drug dependence and abuse criteria and drug abuse treatment modules. The prior prisoner and jail inmate surveys used CAPI for these modules. Second, prior prisoner and jail inmate surveys asked about drug use during the “past month since the inmate’s current incarceration.” However, the NIS asked about drug use during the “past month since admission to the current facility.” Some prisoners or jail inmates may have been in a different facility-- either another prison or a local jail-during the prior month to admission to their current facility. These mode and measurement differences may confound any differences found when comparing estimates over time. In other words, any differences between prior surveys and the NIS may be due to changes over time or due to measurement and mode differences. Therefore, it is difficult to make confident statements regarding change. Furthermore, the measurement and mode differences impact the NIS estimates in different ways. As noted, ACASI is expected to yield higher estimates than CAPI. However, the instrument wording changes in the NIS likely suppress the past month drug use estimate because inmates did not have access to drugs while in another facility. The magnitude of each of these differences is not known, which makes comparisons with past surveys that used different methodologies and question wording difficult. *********************************************** Drug use in the general population *********************************************** Drug use estimates in the general population come from to the NSDUH. To be most comparable to the prisoner and jail inmate population included in the NIS, the NSDUH 2007-2009 survey years were used in this analysis. Using indicators provided in the NSDUH survey, the general population was split into three groups: (1) persons not involved in the criminal justice system during the past 12 months, (2) those on probation or parole during the past 12 months, and (3) those arrested in the past 12 months. These groups are not mutually exclusive in that a person can be both on probation or parole and arrested in the past 12 months. For 2007-09, 1% of respondents said they were on probation or parole and had been arrested in the past 12 months. These persons are represented in both criminal justice categories. Persons in the general population on probation and parole or arrested in the past 12 months should be more similar to the prisoner and jail inmate population than those never involved with the criminal justice system during the past 12 months. Figure 1 and tables 4, 5, 9, 10, and 14 compare the inmate population in prisons and jails to the general population. *********************************************** Standardization of general population estimates *********************************************** When comparing two populations, differences found for some characteristics or conditions may be statistically different as a result of a true difference in the populations or due to basic demographic differences that are associated with the outcome of interest. One method to determine if these demographic differences are the sole cause for differences found for other characteristics or conditions is to standardize the estimates. Standardization of survey estimates consists of calibrating the survey weights for one population such that, for key demographic characteristics that are known for each population, the distributions are identical. This process was done using the statistical software SUDAAN’s PROC DESCRIPT procedure. The resulting estimates are not a representation of the standardized population by themselves (i.e., generalizations about the population cannot be made from standardized estimates), but are appropriate estimates for comparison with other populations of interest. In this report, estimates were standardized for each of the three general population types. For each general population type, estimates were standardized to the prisoner and jail inmate population’s distribution by sex, race and Hispanic origin, and age. Because the prison and jail inmate populations differed, the general population was standardized separately to each inmate population (see appendix tables 3 and 4). For the general, noncriminally involved population, estimates were standardized to the inmate population’s distribution based on race and Hispanic origin, age, and self-reported veteran status. Tables 3 and 12 include standardized estimates to the prison population. Tables 4 and 13 include standardized estimates to the jail population. When standardization is done both the crude (unstandardized) and standardized estimates are presented for comparability. ************************************************************* The Bureau of Justice Statistics of the U.S. Department of Justice is the principal federal agency responsible for measuring crime, criminal victimization, criminal offenders, victims of crime, correlates of crime, and the operation of criminal and civil justice systems at the federal, state, tribal, and local levels. BJS collects, analyzes, and disseminates reliable and valid statistics on crime and justice systems in the United States, supports improvements to state and local criminal justice information systems, and participates with national and international organizations to develop and recommend national standards for justice statistics. Jeri M. Mulrow is acting director. This report was written by Jennifer Bronson and Jessica Stroop of BJS and Stephanie Zimmer and Marcus Berzofsky of RTI International. Verification was completed by Stephanie Zimmer and Marcus Berzofsky of RTI International and Danielle Kaeble of BJS. Brigitte Coulton and Jill Thomas edited the report. Steve Grudziecki produced the report. June 2017, NCJ 250546 ************************************************************* ***************************************************** Office of Justice Programs Innovation * Partnerships * Safer Neighborhoods www.ojp.usdoj.gov ****************************************************** ********************************* 5/16/2017 JER 3:05pm *********************************