Mass Incarceration Is the Elephant in the Room When It Comes to Addiction, Expert Says

About 65% of the U.S. prison population has an active substance use disorder, according to the National Institute on Drug Abuse. That’s because the United States’ response to addiction and substance use disorders is a criminal justice response and not a public health response — but it shouldn’t be that way, one expert said.

“The elephant in the room when we talk about substance use disorders and addiction is mass incarceration, but we don’t address that issue as a country,” said Haner Hernández, an addiction recovery specialist. He spoke on a panel Sunday at Engage at HLTH, a patient engagement summit hosted by MedCity News in Las Vegas.

Those in marginalized communities are disproportionately affected, both in terms of mass incarceration and in accessing treatment for substance use, he added.

“This system that we have built of treatment primarily focuses and is accessible to and has been designed for white, heterosexual males,” Hernández said. “So if you don’t fit that box and are trying to gain access, it is going to be more difficult for you. If you are [LGBTQ+], if you are female and have kids and don’t speak the language, if you are older, if you are younger, if you are a person with disabilities, if you are a person of color in this country, you’re going to have more difficulty gaining access.”

Hernández has first-hand experience when it comes to the difficulties in receiving care for substance use. He began using drugs when he was 18 and spent several years in and out of prison. But eventually, he received treatment.

“I went from prison to treatment not because I wanted to, but because that was an option to get out of prison,” he said.

While in treatment, he was given a job opportunity as a counselor and outreach worker in Boston that entailed helping people on the street receive care. He worked in the field of health and human services for 10 years before he decided to pursue education. He received his bachelor’s in science and human services at Springfield College; his master’s in addiction studies and counseling and psychology at Cambridge College; and his PhD in public health at the University of Massachusetts. His past experience has shaped how he approaches his work now as an addiction recovery specialist, he said.

“The way that my background helps me is that I have had two walks in life,” Hernández said in an interview. “One of having the experience of using substances and being in recovery and the learning that comes from that, from being incarcerated, from experiencing homelessness, from being on the street. The other piece is the academic experience. I understand research and I understand data and I understand evidence-based models and I understand evaluation … It makes me a little more well-rounded.”

While Hernández went down the treatment route for his own recovery, he said there are other paths people can take for substance use, whether that’s medication-assisted treatment, abstinence or holistic processes like meditation. 

But the healthcare industry doesn’t always recognize these multiple pathways to care, he said. It’s vital for patients to have a “menu” of treatment options, Hernández stressed.

“Tonight you’re going to eat. Someone’s going to put a menu in front of you, they’re not going to tell you you’re having hot dogs whether you like it or not,” he said. “Now we like to say that we believe in agency and self-determination and that people have choice. But the reality is that when you look around, we’re imposing solutions on people and then when they don’t work, we’re punitive against those very people. We say, ‘It didn’t work because you didn’t work on it, because you didn’t follow my direction. I believe in choice, and I believe in multiple pathways because the data, the research and experience teaches us that is the way to work.” 

When it comes to fixing these problems with substance use treatment, there are several steps that need to be taken, Hernández said. First, the language needs to change.

“‘Substance abusers,’ we should do away with that language. ‘Addiction, addicts,’ we should do away with that language. ‘Schizophrenics, homeless.’ We should use person-first language and humanize people who have been dehumanized in our society.”

Second, clinicians and the healthcare industry as a whole need to look “inward” in order to treat people of multiple backgrounds, he said.

“We are very good at saying, ‘I’m the expert, you come to me and I will tell you what to do and how to do it. That doesn’t work, it hasn’t worked.”

From his own experience, Hernández left one piece of advice for clinicians and loved ones of those struggling with substance use.

“Never give up on people,” he said. “Believe in people more than they believe in themselves. I can sit here and present to you today with a PhD, I’m certified and licensed, I direct programs in Massachusetts, I teach at the university. I am able to do that because people believed in me more than I believed in myself … To humanize people, to treat people with dignity and respect, doesn’t cost us any money. It just costs a belief that people can do what we think they can do.”

Photo: sorbetto, Getty Images