Addiction Exchange
News from the worlds of research and clinical practice
Volume 3, No. 4: Post Incarceration Syndrome
March 1, 2001
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Funded by Center for Substance Abuse Treatment, SAMHSA
Welcome to Addiction Exchange, a forum for the exchange of clinical practice and research information among clinicians, scientists, educators, and administrators in the field of addiction. This issue on Post Incarceration Syndrome by Terry Gorski is a preview of one of his upcoming presentations at the VAADAC Conference 2001 on March 27-29 in Richmond, Va. Gorski, an internationally recognized leader in the field of relapse prevention, will be the keynote speaker at the Conference.
Post Incarceration Syndrome (PICS) is a serious problem that contributes to relapse in addicted and mentally ill offenders who are released from correctional institutions. Currently, 60% of prisoners have been in prison before, and there is growing evidence that PICS is a contributing factor to this high rate of recidivism.
The concept of a post incarceration syndrome has emerged from clinical consultation work with criminal justice system rehabilitation programs dealing with incarcerated prisoners, as well as addiction treatment programs and community mental health centers working with recently released prisoners.
Post Incarceration Syndrome is a set of symptoms that are present in many currently incarcerated and recently released prisoners caused by prolonged incarceration in environments of punishment with few opportunities for education, job training, or rehabilitation. The severity of symptoms is related to the level of coping skills prior to incarceration, the length of incarceration, the restrictiveness of the incarceration environment, the number and severity of institutional episodes of abuse, the number and duration of episodes of solitary confinement, and the degree of involvement in educational, vocational, and rehabilitation programs.
PICS, which often coexists with substance abuse disorders, is a mixed mental disorder with four clusters of symptoms:
1. Institutionalized Personality Traits resulting from the common deprivations of incarceration, a chronic state of learned helplessness in the face of prison authorities, and antisocial defenses in dealing with a predatory inmate milieu
2. Post Traumatic Stress Disorder from both pre-incarceration trauma and trauma experienced within the institution
3. Antisocial Personality Traits developed as a coping response to institutional abuse and a predatory prisoner milieu
4. Social-Sensory Deprivation Syndrome caused by prolonged exposure to solitary confinement
A fifth cluster, reactive substance use disorders, is caused by the use of alcohol and other drugs to manage or escape the PICS symptoms. Many inmates with PICS who suffer from the symptoms of substance use disorders were addicted prior to incarceration, did not receive treatment during their imprisonment, and continued their addiction by securing drugs on the prison black market. Others developed their addiction in prison in an effort to cope with the PICS symptoms and the conditions causing them. Still others, upon release from prison, relapse to substance abuse or develop substance use disorders as a result of using alcohol or other drugs in an effort to cope with PICS.
The syndrome is most severe in prisoners incarcerated for longer than one year in a punishment-oriented environment, who have experienced multiple episodes of institutional abuse, have had little or no access to education, vocational training, or rehabilitation, have been subjected to 30 days or longer in solitary confinement, and have experienced frequent and severe episodes of trauma as a result of institutional abuse.
The PICS problem will get worse as the prisoner population grows and prisons adapt to the public policy demands for harsher treatment of prisoners, by creating more restrictive and punishing institutional practices; by further reducing access to education, vocational training, and rehabilitation; and by increasing the use of solitary confinement. About 40% of the total incarcerated population (currently 700,000 prisoners and growing) is released each year. In 1995, there were 463,284 released prisoners. By the year 2005, this could increase to 887,000, and by the year 2010 could further increase to 1.2 million. The 60% of prisoners who have been in prison before illustrates the growing evidence that PICS is a contributing factor to this high rate of recidivism.
Upon returning to the community, PICS prisoners have high rates of addiction and mental illness, tend to relapse if previously addicted or mentally ill, are at high risk of chronic unemployment and homelessness, and often return to a life of aggression, violence, and crime. Most communities will be unable to reabsorb returning PICS prisoners because they are less likely to get jobs, and more likely to commit crimes and disrupt families. As these returning prisoners overwhelm addiction and mental health service providers, they could destabilize blue-collar and middle class neighborhoods, turn many lower middle class areas into slums, and turn inner city communities into war zones
PICS can be prevented by changing the public policies that call for incarcerating more people for longer periods of time and for less severe offenses. These policies also call for more punitive environments that emphasize the use of solitary confinement, and eliminate or severely restrict prisoner access to educational, vocational, and rehabilitation programs while incarcerated. PICS can be effectively managed by expanding community-based addiction and mental health programs and training professional staff to meet the needs of released prisoners.
Terence T. Gorski can be contacted through the CENAPS® Corporation, 17900 Dixie Highway, Suite 14, Homewood, Illinois 60430; phone 708-799-5000; fax 708-799-5032; web site
http://www.cenaps.com; e-mail
http://www.mid-attc.org/wwwboard/wwwboard.shtml to discuss this topic on the Addiction Exchange Forum.
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