The criminal legal system (previously referred to as criminal justice system) and alcohol treatment in the United States (US) have long been intertwined, with almost 1/3 of arrests in the US involving alcohol (McSweeny, 2015). Though the racial inequities in the criminal legal system in the US has been long known (Kovera, 2019), little research has examined what this means for alcohol use treatment that involves the criminal legal system, and if these inequities exist in treatment settings as well. New research has recently been released outlining racial disparities in the relationship between the criminal legal system and alcohol use treatment in the US. This research shows significant inequities in both who is referred to treatment by the criminal legal system, and the impact of that referral on treatment completion.
US Criminal Legal System and Alcohol Use Treatment
If someone in the US is arrested and charged with an alcohol-related crime, they are very often required to complete certain treatment requirements (i.e. attending treatment or abstaining from drinking) in order to avoid legal consequences. These consequences are generally determined either by a parole/probation officer or a judge and can include increased time on probation/parole, new charges, and/or re-incarceration. Clinically, this means that clinicians working within these spaces must be knowledgeable of the needs of their client, but also the needs of the criminal legal system and their client’s individual case.
Recent literature has consistently pointed to the increased rate of treatment completion among people who are referred by the criminal legal system. Time and again we see that people on probation and parole complete treatment at higher rates than those who enter treatment voluntarily (Stahler et al., 2016). Scholars have subsequently theorized that this increased completion is due to the positive impact of accountability and threat of consequences that makes one take treatment seriously and foreseeably recover at higher rates (Anglin et al., 2012, Chandler et al., 2009).
These theories however often ignore the many additional consequences and impacts of involvement in the criminal legal system, such as the demands of contact with a probation/parole officer, community service, vocational requirements, and continued stigma in educational and employment settings against those with a criminal record (Labrecque, 2018). These consequences are even more stark and prevalent for People of Color, who are disproportionately targeted by the criminal justice system in the US (Kovera, 2019).
In our look at 749,349 cases across substance use treatment settings in the US, we not only found that the “benefit” of the criminal legal system on treatment completion was not true for all people, but also that significant racial disparities exist in who is referred to treatment by the criminal legal system.
Takeaway #1: The disproportionate involvement of the criminal legal-system in the lives of American Indian and Alaska Native people
Compared to all other racial groups, our research found that American Indian and Alaska Native people were 1) significantly more likely to be referred to alcohol treatment by the criminal legal system, and 2) had a significantly smaller association between criminal legal referral and alcohol treatment completion (i.e. the criminal legal referral was significantly less influential in predicting treatment completion). This research, as well as previous studies, have consistently shown the disproportionate impact of the criminal legal system on the lives of American Indian and Alaska Native communities throughout the US (Gameon & Skewes, 2021; Lantz & Ward, 2023). These new findings further solidify this impact and extend it to alcohol treatment.
Takeaway #2: Treatment completion comes with a cost when involving the criminal legal system
Though not the focus of the current analysis, the authors recognize it is important to provide context when discussing treatment that involves the criminal legal system. Specifically, though the current study found that most participants reported greater likelihood of treatment completion if they were referred by the criminal legal system, involvement in this system comes with its own set of known consequences and requirements that are not conducive to recovery. These consequences commonly extend to educational, legal, vocational, and relational contexts (Kimble & Grawert, 2024). For example, it is known that a criminal felony charge on one’s record can exclude someone from specific vocational or educational training or certification programs (Kimble & Grawert, 2024). When people are on the job market, they often experience discrimination in hiring and in the workplace. Finally, the requirements of probation or parole in the US is often intensive and includes multiple in-person meeting requirements with treatment providers and probation/parole officers, a requirement that is made much more difficult for those without financial or relational resources to assist with transportation, scheduling etc. (Kimble & Grawert, 2024).
Takeaway #3: Alternatives to the criminal legal system can be just as effective in promoting treatment completion, especially among American Indian and Alaska Native people
With the exception of American Indian and Alaska native people, the current findings mirrored previous literature in showing increased likelihood of treatment completion among those who had been referred by the criminal legal system compared to those who had been referred from other sources. Though an important point to consider, researchers and readers are encouraged to view this association within the context described above, of the multiple consequences of involvement in the criminal legal system as a whole. Taken together, we can acknowledge the association between treatment completion and criminal legal referral, and also acknowledge and advocate for other solutions outside of the criminal legal system to encourage treatment completion and recovery in alcohol treatment in the US.
Along these lines, one encouraging finding of the current study was that the benefit of criminal legal involvement on the likelihood of completing alcohol treatment didn’t extend to everybody. In fact, Alaska Native and American Indian people were equally as likely to complete alcohol treatment regardless of whether they had been referred to treatment by the criminal legal system. This finding highlights the potential for non-criminal legal referral sources to have just as successful treatment completion rates as those who are referred by the criminal legal system. Though the current study wasn’t able to determine exactly why this finding exists, future research is needed to understand the potential of non-criminal legal referral sources and hear from American Indian and Alaska native communities around the US on where this worked for them in recovery and treatment.
Conclusions
Taken together, the current findings, paired with the known and longstanding consequences of criminal legal involvement, point to a need for alternative routes to alcohol use treatment outside of the criminal legal system. In particular, future scholars could benefit from focusing on the meaning and impact of community in recovery and treatment. Similar to our recent conceptualization of learning, alcohol treatment literature is increasingly pointing to the efficacy of a reinforcement and supportive model as compared to one with punishment and/or consequential accountability (Tomaz et al., 2023). This shift can open the door to not only understand the impact of community in recovery, but also work with communities to understand what is working for them, where social sciences can be of support, and how future literature and advocacy can capture this potentially positive impact on the lives of those in recovery.
Written by Dr Madeline Stenersen, Assistant Professor, College of Arts and Sciences, Saint Louis University, United States.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.
Article: The criminal justice system in alcohol use treatment: a nationwide analysis of racial disparities in treatment referral and completion, Alcohol and Alcoholism