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Will Prison Actually Help This Teen Mom Star?

Amber Portwood, troubled star of the MTV reality show, won praise and press by opting for prison over rehab for her drug crimes. But if drug treatment made her suicidal, incarceration is likely to be even worse.

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Portwood on "GMA" last week photo via

By Maia Szalavitz

06/11/12

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I will admit to not being a fan of reality TV and having never watched Teen Mom star Amber Portwood whose last appearance aired last night. But while I wouldn’t presume to write a review of a show I’ve never seen, lack of knowledge of addiction is not stopping pundits across the net—including the Daily Beast’s Mansfield Frazier and Jezebel’s Tracie Egan Morrissey—from claiming that her five-year sentence for failing drug treatment will help save her life. (Morrissey even claims that the reality TV show, which features the trials and tribulations of girls who have illegitimate children, itself already helped save her life, itself but that’s another story.)

Indeed, the 21-year-old MTV reality star reportedly chose prison over treatment because she felt so depressed after two months in rehab that she would rather “do my time and get it over with.” Her "relapse"—in which she took 30 Suboxone tablets—was actually a suicide attempt.

A drug court had originally ordered Portwood to treatment after she was arrested for illegal possession of over 40 opiate and other addictive medications. At the time she was on probation stemming from charges of domestic violence committed against her ex-fiance, Gary Shirley, while they were filming a Teen Mom segment. Then, in May, she failed a urine test.

“I’m going to get my GED [and] try to better myself for when I do get out,” Portwood told Good Morning America. “I’ll be off the drugs, I’ll have an education to get me a job—you have to think of the positives in this negative story.”

While many addicts will claim that prison kept them from dying on the street, there is no evidence to support this idea.

Prison, however, is not a positive. Let me put this very simply. Incarceration does not prevent, treat, control or cure addiction. It does not save lives, except perhaps when violent prisoners are locked up and kept from killing others. It often makes addiction worse. It is expensive, counterproductive and absurd. Until we call out everyone who makes this silly claim and rid public discourse of this falsehood, we’re not going to fight addiction effectively. Unfortunately for her, Portwood seems to have swallowed the pro-prison propaganda whole.

While many addicts will claim that prison kept them from dying on the street, there is no evidence to support this idea. The risks related to being in prison outweigh any possible benefit of possibly having less access to particular substances. And we all know, of course, that prisons and jails are not actually drug-free.

Sexual victimization rates alone are horrendous. 10% of state prisoners report having been sexually victimized during their last period of incarceration—half of them by guards, not inmates. Women were at highest risk with 14% reporting sexual abuse. We know that sexual abuse increases the risk of addiction—does anyone seriously think putting people at greater risk of it will help?

Being female, being newly incarcerated and being involved with the prison economy—as is likely for someone who has an addiction and is seeking drugs—all increase risk for being victimized. Being a reality TV star probably doesn't help, either.

Rates of violent assault are even higher: 35% of male and a full quarter of female inmates report having been physically attacked while incarcerated. Again, being abused leads to greater addiction risk, not less. Both rape and assault can lead to PTSD, which actually doubles addiction risk.

Moreover, only 15% of people in prison have access to addiction treatment, with virtually no access to maintenance for opioids that would meet the standard of care for the addiction to pills Portwood has. The idea that simply isolating someone from drugs (if that were actually possible in prison) will cure their addiction was debunked decades ago.

While Portwood is being sentenced to the Indiana Department of Corrections therapeutic community program, this is a drug-free program that does not provide maintenance.

Even worse, American therapeutic communities (TCs) are based on the confrontational and hierarchical approach pioneered by Synanon. While most have dropped the humiliating and harsh tactics that helped turn Synanon into a cult, this is not true for all. If this program is staffed by counselors trained in the earlier approach, she may actually get treatment that is harmful.

To top it all off, prisons have an equally poor record for providing appropriate care for people with both addiction and mental illness, from which Portwood also suffers. The harsh TC approach has been found to be particularly dangerous for women and for people with co-existing psychiatric conditions.

While prisons have actually become the largest provider of “care” for the severely mentally ill, no one actually believes they treat these disorders. Why would it be different for addiction anyway? And does anyone really believe that prison will make someone less suicidal?

Pundits should not be applauding Portwood’s poor choice clearly made while depressed (and against her own lawyer’s advice) when she appeared before the judge last week. People talk all the time about how addiction distorts thinking and decision making—but that’s equally true of depression.

Pundits should not be applauding Portwood’s poor choice clearly made while depressed (and against her own lawyer’s advice).

We should decry both the pathetic treatment that Portwood likely received in rehab and the criminal justice system that will spend tens of thousands of dollars caging someone when what she really needs is high-quality addiction and mental health care. We should also decry the medical system that buys into this absurd treatment of the mentally ill and benefits from being as "an alternative to incarceration," rather than protesting this kind of sentencing.

We'll probably never know what the rehab counselors said to her when she decided she wanted incarceration. But any program that did not vigorously oppose a suicidal patient's desire to go to prison deserves to have its license revoked for malpractice. How could a competent clinician possibly see prison as a better alternative?

We’re supposed to not further people’s self-destruction but to stop the spiral. Treatment providers are entrusted with advocating for the health of their patients, not stand by as their patients make ill-advised decisions that will harm them. Ignoring the data and pontificating from ignorance about the usefulness of prison isn’t helpful. We’re not going to get better drug policy until we confront everyone—including treatment providers—who spreads the myth that prison saves addicts’ lives and start emphasizing the reality of its emotional, psychological and financial costs.

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006). 

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