It’s 2 a.m. when the dorm sergeant kicks my bed.
“Get dressed, inmate, and report to medical.”
As a volunteer enrolled in the Florida Department of Corrections’ “substance abuse treatment” program provided by GEO Group, I am subject to monitoring by urinalysis screening for opiates, cannabis, methamphetamine, and alcohol. Testing is random and I can be called to produce a sample at any time of day or night.
My treatment plan is marked as “prevention” because I am currently clean and sober. Three days a week, I attend motivational and behavior modification classes. Drug education, sober living skills, integrity training, parenting, anger management, financial planning, and employment skills are among the choices.
Today’s session is called “Thinking for a Change.” Twelve women take turns drawing slips of paper from a box. Each slip contains a question. My slip asks: “What resources can you use to support your recovery upon your release from prison?” For fifteen minutes I write a plan for finding a twelve-step meeting in my neighborhood and finding a sponsor. Many prisons allow community volunteers to offer twelve-step programs, which don’t require monitoring for substance use. Florida does not permit this.
We pass the slips around the circle until all have been read. Linda, a recovering opioid addict, holds up a slip. “How would you turn down drugs at a party?” We laugh and popcorn answers out: “Make mine a Snickers bar!” Another woman calls, “Chew bubblegum!” Stacy, a Monty Python fan, shrieks, “Run away, run away!”
The ugly truth is that no one in our class has been successful in avoiding relapse inside or outside of prison. This is my third round of substance recovery classes; others in my group have struggled even longer. One big reason is that the Florida Department of Corrections offers solely abstinence-only treatment options. These programs simply aren’t effective: 49 percent of people incarcerated in state prisons meet the criteria for substance use disorder, the medical diagnosis for drug addiction. In Florida I’ve seen many people return to prison after failing to maintain sobriety upon release.
To end up in a drug “treatment” class in Florida prison, you’re either identified by a record of felony drug charges, or you can request addiction treatment on a voluntary basis. From there, you’re funneled into abstinence-only drug rehabilitation education and counseling services provided by private companies such as Gateway Rehabilitation (offered at Lowell Main Unit and Lowell Annex, the facility where I was previously incarcerated) and GEO Group, which offers the program at Homestead Correctional Institution where I am incarcerated now.
These programs frame addiction as a moral problem, the result of personal choices. They ignore the physical medical causes of addiction and refuse to diagnose or treat us. Instead, we are left with classes that hold little relevance for the chaotic environment we live in; then, when we leave prison, we encounter a total lack of support. The validity of medically-assisted treatment—which many women had previously relied on—is ignored.
Abstinence-only treatment holds a level of irony in a prison setting. Despite a move to paperless mail and strict physical search requirements for visitors and community volunteers, drugs continue to flood into prisons. From suboxone and CBD to methamphetamine and other street drugs, people suffering from drug addiction can’t catch a break and relapse over and over again while serving their sentences. For others, the abstinence-only treatment disrupts their prior medically-assisted treatment.
J., a forty-six-year-old woman, is serving a prison sentence for trafficking linked to her personal struggle with substance use disorder. Over coffee and cinnamon rolls, I asked her to tell me her story.
“As a teen I was treated for complications of ovarian cancer,” she says. “The doctors gave me Darvocet and Tylox. My last prescription was for 120 Percocet monthly.”
“In 1999 I was diagnosed cancer free. I didn’t know I was addicted. I still needed the pills. My parents had pain management prescriptions for oxycontin. The prescriptions came through the mail direct from Perdue.”
By 2017, after years on the detox and relapse merry-go-round, J. ended up in court for drug possession. She was sentenced to treatment for substance use disorder at an inpatient addiction recovery clinic. “Suboxone therapy changed my life,” she recalls. “For the first time I felt normal and had no cravings.”
But then the clinic closed. J. couldn’t find another doctor to take her insurance. “Soon I wanted drugs again. All I could think about was getting high. That’s when I tried meth.”
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“My mother didn’t know I relapsed,” J. admits. “I couldn’t tell anyone that I was using again.”
Since 2004 J. has been in and out of the criminal legal system, with more than fifteen charges related to addiction. In substance use disorder, the brain receptors have been hijacked. The part of the brain responsible for judgment and executive function is rendered ineffective. This can compel people who would not ordinarily do so to commit crimes to get money to feed their addiction.
J. is still using in prison. Despite her desire to break her addiction, she can’t access any treatment plans at the facility, because GEO Group requires her to take part in monthly drug testing. “I can’t take the risk of failing and getting a disciplinary report on my record,” she says.
It’s more than just a report—the consequences are severe. If caught failing a drug screen test, J. could receive up to sixty days in solitary confinement, be removed from recovery programs for up to a year, and be disqualified from an early release from prison.
L., a forty-three-year-old woman, returned to prison from a work release center after testing positive for Suboxone.
“I’ve been a functional addict most of my life,” she says. “Almost everyone in my family had scripts for oxycontin . . . they used to give me pills as treats. Prison made me want to change.” She began engaging in the GEO program and twelve-step meetings. She tried running, yoga, meditation, and Zumba. “My cravings never stop,” she tells me. “I keep using again and again, even in prison.”
Last year, a judge granted L. “relief on appeal” and reduced her prison sentence by ten years. She was transferred to a work release center, a low-security alternative to prison. L. was allowed to get a job as a waitress and save money for her transition back to the community.
“My mother died and I couldn’t get over it,” she says as tears well up in her eyes. “My addiction woke up. I needed help. I submitted a request for permission to make an appointment with a local doctor on my own time and with money I saved in my trust account at the center.”
The Florida Department of Corrections allows people at work release centers to make private medical appointments, but L. faced too much red tape. “I would request permission to go to an appointment, the officers would verify it, and then I would be denied a pass or delayed leaving the center so long that I’d be hours late.”
If she requested counseling or antidepressants from the Department of Corrections, L. would be classified as a security risk and returned to prison. The Department of Corrections policy broadly denies treatment for substance use disorder—leaving L. few realistic options.
So she began purchasing Suboxone illegally with the tips she earned from waitressing. “It helped me to stop craving opioids and meth,” she says. “I was sleeping enough and eating healthier. I could concentrate on working and plan for my future. Life was bearable and almost normal.”
But completing regular substance abuse and alcohol testing is required for a person to remain in work release. She lasted eight months before failing a screen for Suboxone. She returned to Homestead to complete the remaining months of her sentence.
L. and J. are just two individuals within a prison full of women struggling with addiction, given few real resources, with the only “treatment” options being abstinence-based.
As I finished writing this story, we heard of the overdose deaths of Kristie and Brittany, two women who relapsed less than thirty days after walking out of the prison gate. Brittany received her GED days before her release; Kristie was anticipating reuniting with her children.
Florida’s refusal to treat substance use disorder with medication therapies virtually assures relapse upon release from incarceration. Medical treatments for addiction as a physical illness is a public health investment in building a healthier and safer community by preventing relapse and return to prison.
This essay was produced and published in partnership with Empowerment Avenue.
Image: Eugene Chystiakov/Unsplash
