A new place to attack the opioid crisis

There's a strong connection between addiction and crime.

More than 80 percent of inmates in New Jersey's prisons have an addiction issue, were under the influence when they committed their crime, or committed a crime linked to their drug use, according to the state's chapter of the National Council on Alcoholism and Drug Dependence.

When former Gov. Chris Christie announced the reopening of Mid-State as a rehab prison a year ago, he said it would give inmates an opportunity to stop the cycle of addiction and crime.

"I don't think you can give people a second chance with both hands tied behind their back," he said. "Drug addiction ties their hands behind their backs."

For its new mission, the facility underwent a 19-month, $28 million renovation. There are 600 men in the voluntary treatment program now, and another 40 inmates handle work responsibilities around the prison. Some of them are graduates of the treatment program.

The state's only women's prison, Edna Mahan Correctional Facility in Hunterdon County, offers the same program in a section of that facility, with about 65 women taking part.

The Gateway Foundation contracted with the state to provide drug treatment services at Mid-State for five years at a cost of $29.2 million, while Rutgers' University Correctional Health Care provides medical services. The annual appropriation for substance use disorder services at Mid-State is $4 million, with another $3.9 million for inmate health care.

From the outside, Mid-State looks like most other prisons. There are high fences, barbed wire and a guard tower. What's happening inside, though, is unique in New Jersey and the nation.

The primary addictions treated here are alcohol, cocaine and tranquilizers, but most are addicted to heroin and other opioids.

"We treat every kind of addiction here ... you name it, we treat it," said Alfano, director of substance use disorder programing for the Gateway Foundation. "We also have a gambling program."

Once there, inmates receive anywhere from 7 to 28 hours of treatment a week.

In a large room at Mid-State, about 30 inmates dressed in standard-issue beige outfits and white sneakers sit on rows of chairs as a counselor talks about choices. Inmates talk about the choices they've made, and their regrets. It looks like a classroom, complete with a chalkboard.

An inmate in the front row raises his hand to share his story.

"I'm here because I really want to change. I want to do things differently before it's too late," says Daymon Foster, who is serving time on a weapons charge. "I've been getting locked up since I was 11. I ain't never learned as much stuff as I've learned here."

Before Mid-State's new mission, inmates could seek drug treatment in "therapeutic community" programs at six prisons in the system. These services were only available toward the end of an inmate's sentence and were unlicensed, meaning if inmates made progress, they would need to restart treatment from the beginning when they were released.

In addition, Narcotics Anonymous, Alcoholics Anonymous, Gamblers Anonymous and other recovery services were available to inmates not in the therapeutic communities.

Consolidating multiple unlicensed programs into one licensed, intensive-treatment program at Mid-State allows for more consistency and better outcomes, said Dr. Herbert Kaldany, the state Department of Corrections' director of psychiatry and addiction services.

Services are now available throughout an inmate's sentence and they remain in these programs as long as the professionals treating them believe they need help. More than 100 inmates have already completed treatment at Mid-State.

Inmates not at Mid-State because they don't qualify for a medium-security facility still have access to these same services throughout the prison system.

Some halfway houses offer licensed outpatient treatment, too, and Department of Corrections can connect parolees with community providers who can continue medication-assisted treatments.

While some might think that nothing cures addiction better than a few years in prison with no access to drugs, that's not how it works, explained Dr. Tisha Wiley, assistant director for criminal justice at the National Institute on Drug Abuse, a federal research agency within the National Institutes of Health.

"Addiction is a chronically relapsing brain disease," Wiley said. "What this means is that even when people don't have access to their drug of choice, many of the factors that led to, and maintained their addiction, remain."

Drugs such as heroin change how the brain works.

"For opioid addiction in particular, people with an opioid-use disorder have often experienced fundamental changes in how their brain reward systems function," she said.