Friday, December 28, 2012

Critical Perspectives on Addiction Published!







Nancy Campbell


Kerwin Kaye


Marc Elam



Helena Hansen and Samuel Roberts


Jessie Daniels



Deborah Potter


Teresa Gowan and Jack Atmore



Jessica Parr and Nicolas Rasmussen


Zoe Meleo-Erwin


Luther Elliott, Geoffrey Ream, and Elizabeth McGinsky

Sunday, April 15, 2012

Why a volume on addiction now?

The newest (and very rough) installment on draft introduction to Critical Perspectives on Addiction volume in the Advances in Medical Sociology series.

photo by mararie on Flickr

So much has been written about addiction, one can reasonably ask why we need another volume on the subject now. The pieces gathered here take up a number of current trends that make now exactly the right time to take a fresh look at addiction.  These include: debates over the nosology of addiction as part of the revision to the Diagnostic and Statistical Manual of Mental Disorders (DSM); the expansion of addiction’s meaning and spheres of control beyond alcohol and illicit substances; the rise of neuroscience, the increasing “pharmaceuticalization’ of everyday life, and new pharmaceutical treatments for addiction; increasing awareness about the intersection of the drug war and the mass incarceration of people of color; and new theoretical frameworks for understanding the role of addiction a fundamental technique of social control, through the structuring of norms, the promotion of self-governance, and the continued use of overt state power.  These trends are reshaping addiction in both new and not-so-new ways that warrant the study and exposition this volume seeks to provide.

The newest edition of the DSM is due out in May 2013. The DSM is important not only because it is widely used both in the U.S. globally in diagnosing mental “disorders,” including addiction, but also because it reflects the “politics of designation” (Conrad, 1992; see also Widigier in Sadler book on DSM).  Simply put, it exposes both the current political, historical and social context as well as power struggles over how and by whom a given disorder will be defined.  The DSM V is being developed by groups of mental health professionals who draw both on research and discussion among themselves (website).  An enormous amount is at stake in how these groups end up defining a “disorder.”  Often, it is only by taking on a DSM diagnosis (and its attendant stigma) that individuals can access services and providers can access payment.  Increasingly, the DSM is also finding its way into the criminal justice system, both in instances of psychiatric defense and in medico-legal hybrid institutions, such as drug courts.

Importantly, for the first time, the DSM V will include non-substance addictions, specifically gambling.  The inclusion of a host of other “compulsive behaviors” has been also been debated (cite).  This marks a key turning point in the definition of addiction, which has historically focused on “dependence” and “abuse” and tied addiction to psychoactive substances. As the quote below from Peele (2010) suggests, the DSM V debates have further upset addiction’s already ambiguous meaning:

DSM-V proposes to incorporate some non-substance addictions - notably gambling. (Internet addiction is still up in the air - will the Task Force decide if it is addictive by a PET scan or by majority vote?) But DSM-V will call whatever ends up in this category behavioral addictions. So, let's count up. There is hypersexuality, but it is not an addiction. There is gambling, which is a behavioral addiction. Internet fixation may be an addiction, or maybe not. And then there are alcohol and drug addiction, formerly called dependence, in a separate substance addiction category. Clearly, the DSM-V Task Force is confused.[i]

The debates over the expansion of addiction beyond psychoactive substances are rooted, at least in part, in contemporary neuroscience, which is playing an increasingly important role in constructing “addiction.”  Although the science itself has been critiqued (cites), neuroscience has been used successfully to frame addiction as a chronic, relapsing brain disease (cites).  Campbell, for instance, argues that “neuroscience hijacked the field of substance abuse research… and gave substance abuse research the stamp of legitimacy” (2007: 200-1).

Moreover as the debates over the DSM V suggest, addiction neuroscience is being used to substance use to elucidate phenomena beyond substance use.  Specifically, the notion that the brain’s dopamine system is the center of pleasure has been used to explain all manner of behavior, both “pathological” and pleasurable.  Scans of the brain’s pleasure center “have revealed an embarrassment of riches” (Reinarman 2007; see also Vrecko, 2010b).  Gambling, eating, sex, and a host of other activities all “light up” the pleasure center, and scientists are now suggesting a common pathway theory: pleasurable behaviors stimulate the dopamine system and, therefore, tend to be repeated. 

The expansion of addiction to encompass a range of “pleasures” is not just a taxonomic debate; it shifts addiction in ways that reinforce “healthism” and neoliberalism.  The danger is less illicit drugs – though we still demonize many of those – but pleasure more generally, and pleasure is increasingly read as risk (Mackenzie, 2006).  On the one hand, pleasure is at the core of and drives consumer capitalism.  On the other hand, an expanding array of addictions and “diseases” (e.g., obesity) are seen as the result of excess pleasure.  The regulation of pleasure to encourage consumption but avoid becoming “addicted” or “sick” becomes a powerful tool in promoting the self-governance of individuals.  Individuals, with the help of public health messaging, medicine and cultural representations more broadly, are encouraged to police themselves and control their appetites in order to preserve health. 

The rise of addiction neuroscience has also led to the promotion of medications to help those who may fail at controlling their appetites through the assertion of will powere by targeting the biochemical processes of their brains.  The advent of new addiction pharmaceuticals can be seen as part of the increasing pharmaceuticalization of society more broadly, wherein pharmaceuticals are seen as the solution to ever-expanding array of personal and social problems. Between1980 and 2003 the average annual amount spent by Americans on prescription drugs rose from $12 billion to $197 billion (Petersen, 2010).  The rise of neuroscience means that behavior that deviates from the norm is more and more likely to be understood in biological terms as some sort of dysfunction of the brain.  Treatment with medication inevitably follows: “if the problem is neurologically based, it should be treated with a drug” (Diller: 1998: 110).  Medications have played an important role in attempts to to advance the medicalization of addiction (see Courtwright).  The development of one such drug, buprenorphine, in fact, was used to justify a remarkable legislative change in 2000 that permitted physicians to prescribe a narcotic (buprenorphine is an opioid) for the treatment of addiction in an office-based setting (i.e., not a methadone clinic) for the first time since 1914. 

Despite these efforts to frame and treat addiction as a medical disorder amenable to pharmaceutical intervention, behavioral, punitive, and morally-inflected responses to addiction continue to dominate drug policy and drug treatment. Indeed, programs focused on helping individuals achieve “abstinence” through behavior change still make up the majority of treatment in the U.S.  (SAMHSA 2010).  Gowan (2012) has noted the peculiar melding of the medical and moral in our contemporary approaches to drug treatment:

The current impulse toward reform and rehabilitation also has its new and peculiar specificities. At once medicalized and deeply authoritarian, riven with anxiety about self-control and ‘choice’ – the rise of drug courts and strong-arm rehab reflects the peculiar prominence of addiction within the current American Zeitgeist (71).”

Alongside our medical and behavioral treatments for addiction stands the real and present danger of incarceration. Drug offenses accounted for two-thirds of the rise in the federal inmate population and more than half of the rise in state prisoners between 1985 and 2000 (Alexander, 2010).  In her highly acclaimed and popular book, The New Jim Crow, Alexander argues that the war on drugs has undermined fundamental civil liberties and created a new system of racial oppression:

The fact that more than half of the young black men in many large American cities are currently under the control of the criminal justice system (or saddled with criminal records) is not—as many argue—just a symptom of poverty or poor choices, but rather evidence of a new racial caste system at work. 

Work like hers has reinvigorate the debates over the criminalization of addiction and heightened awareness about how racialized our attitudes about and responses to addiction are.

This volume, then, emerges at curious time in the history of addiction.  The very meaning of the word is in dispute (again), and yet the confusion over its meaning has done little to slow addiction’s growing dominion over a host of behaviors ranging from eating to online gaming.  The popularization and influence of neuroscience and the development of addiction pharmaceuticals, which have undergirded the expansion of addiction, seem poised to finalize the accomplishment of addiction as a disease and, as such, the appropriate province of medicine.  And yet, addiction remains inextricably bound with morality and stigma and linked with the exercise of racial oppression through the mass incarceration of people of color on drug charges.  Whether through reinforcing neoliberal desires for self-governance and control, placing “addicts” under the authority of a doctor, or locking up “criminals,” addiction has become one of our most expansive and influential systems of social control.

These responses to addiction and the hybrid versions of them that seem to be emerging are contained with a larger sociopolitical context that is highly stratified, particularly by gender, race and class.  There is no singular Truth about addiction, and because there is not, it can be deployed differentially in ways that reflect existing gender, racial and social stratifications.  It is these deployments and the ways they reflect our contemporary society that this volume addresses.

Saturday, April 14, 2012

Sociology and the Addiction Kaleidoscope

Snippets from the draft introduction to "Critical Perspectives on Addiction" for the series, Advances in Medical Sociology.

photo by Lucy Nieto on Flickr
“Addiction” is increasingly being used to explain all manner of human behavior.  Just a few recent headlines from the New York Times reveal how varied and expansive our ideas about addiction have become. 

“When is gambling an addiction?”
“A wave of crime and addiction with the medicine cabinet to blame”
“Miss G.: a case of internet addiction”
“When tanning turns into addiction”
“In the cave: philosophy and addiction”
“Is sex addiction an excuse?”
“Can food be as addictive as a drug?”

Although addiction appears to be becoming a dominant interpretive framework, what we mean by “addiction” if far from clear.  Sociologists have characterized attempts to classify and define “addiction” variously as a “shifting kaleidoscope” (Room, 1997), “taxonomic unruliness” (Keane, 2002), and “conceptual acrobatics” (Reinerman, 2005).  Lindesmith, widely considered to be the founder of the sociology of addiction wrote in 1938: “The problem of drug addiction has been an important one in this country for several decades and has proved to be a difficult one to handle from a theoretical as well as from a therapeutic standpoint (593).”

Unfortunately, it appears that neither the passage of time nor the advent of new technologies and scientific frameworks have done much to clarify theories of addiction.  In 1980, the National Institute of Medicine published a monograph that included 43 separate theories of addiction from a range of disciplines.  Ever malleable, addiction takes on the latest scientific theories of the day; just in the past 50 years it has been described as a metabolic, genetic, and, most recently, a neuroscientific problem.  As this volume will demonstrate, the malleability and chameleon-like qualities of addiction give it a conceptual elasticity that allows it to be deployed strategically to not only explain an ever-widening array of behavior, but also as a targeted tool of social coercion and control.

From a sociological standpoint, addiction is important because it engages a number of core theoretical issues – each of which is taken up in this volume.  First, addiction– often defined by a loss of control -- troubles issues of structure, agency, and free will.  Second, drug use – or at least some drug use -- remains stigmatized and criminalized, and thus addiction plays an important role in our systems of social control and racial segregation.  Third, addiction, especially as its meaning has expanded, engages key questions about pleasure, rationality, and self-control in ways that reinforce new forms governance and neoliberal citizenship.  Fourth, there is an ongoing and vigorous debate over whether addiction exists purely as a cultural, social and representational phenomenon (a social construction) or has some “real,” material, or biological basis – a key tension in sociology more broadly.

Finally and related, addiction has long been understood as having both medical and moral component making it an especially interesting and important topic for a series on medical sociology. There has been no graceful arc from deviance to medicalization – from badness to sickness -- in the case of addiction.  Although the medical model of addiction has gained in prominence in the U.S. over the past thirty years, scholars have noted neither alcoholism (Appleton 1995; Valverde 1998) nor drug dependence (Smart 1984) fit easily into the medicalization model. The slippage between medicine and morality, a characteristic of many medicalized conditions, has been especially pronounced and problematic throughout the history of addiction and has contributed to the ambiguity in how we understand addiction and addicts.   This ambiguity plays out in real, materials ways that have shaped an often chaotic and inconsistent approach to drug policy, specifically, and response to addiction more broadly.

While the medical and the moral are often pitted against one another rhetorically, our responses to addiction often contains elements of both.  As May (2001) explains “clinical constructions of addiction still engage a set of moral questions” (386).  These moral questions are often directly built into addiction treatment programs, many of which have explicit crime control functions (Fox 1999) but rely on medical language to describe addiction. Medical and moral views of addiction have also increasingly blurred through criminal justice practices such as drug courts, where defendants with drug-related offenses are mandated to drug treatment (Tiger 2008).

Even when addiction is understood as a disease, because it is a disease that involves the “loss of control,” it often used to justify extreme forms and systems of coercion and social control. As Reinerman (2005) puts it:

[T]he disease concept sometimes serves as a human warrant for the right of access to services, but is also serves, paradoxically, as the key justification for punitive prohibition…. It is a weapon that helps justify – ‘for their own good’—the suspension of the Bill of Rights … and the mass incarceration of the powerless (317).

Indeed, even as disease models of addiction have gained traction, criminalized approaches to drug use have continued to play a large role in drug control policy, especially in the U.S.  The increasing criminalization of drug use over the past thirty years, as evidenced by lengthy mandatory sentences for drug convictions and dramatic increases in federal funding for the “War on Drugs,” has had a significant impact on the number of people incarcerated in the U.S., now exceeding 2,000,000 (Glaze and Palla 2004) and has become a firmly entrenched and powerful tool of racial control (Alexander, 2010).  Although Black Americans are no more likely than whites to use illicit drugs, they are for more likely to be incarcerated for drug offenses (Rich et al. 2011).  Black men in the U.S. are more likely to have been in prison than to have graduated from college or joined the military by middle age (Rich et al 2011). 

Saturday, February 25, 2012

Is the medicalization of addiction benign?

      I've been revisiting my dissertation for a book project.  Here are some of my conclusions based on my analysis of buprenorphine, a pharmaceutical treatment for opioid dependence.
Elizabeth Pisani (2008) in The Wisdom of Whores argues that a substantial portion of the funding devoted to HIV/AIDS is wasted on ineffective programming because science and good public health policy are trumped by politics, ideology, and "morality."  The same is true for current U.S. drug policies.  As my analysis of the social construction of bup has illustrated, the current classification of drugs as legal or illicit is at best irrational and at worst driven by racism (Mosher & Yanagaisako 1991).  In a culture that is increasingly medicalized and pharmaceuticalized, problematizing all “non-medical” use of substances will further exacerbate our already unjust and ineffective policy responses to drug use. 
            The use of illicit drugs is spread throughout society fairly evenly, but the harm that results from them and our responses to them are not.  Legal drugs, in fact, cause far more social and health problems than illicit ones (Mosher & Yanagaisako 1991), and our response to illicit drugs (arrest and incarceration) causes profound harm to individuals, families and communities (Global Commission on Drug Policy 2011).  One the face of it, medical approaches to drug use seem kinder and more benevolent than criminal justice approaches.  But, as I have argued, one does not preclude the other; both have and will continue to co-exist.  It seems increasingly likely that some drug users will be treated medically, and others will be locked up, escalating rather then diminishing the racial disparities that characterize U.S. drug policy.  Moreover, I have also argued that medicalized approaches do not necessarily reduce individual blame or stigma but rather merely cloak moralistic arguments in the language of science.  More perniciously, medicalized approaches, especially neuroscientific ones, radically individualize the problem of drugs and erase the effects of social factors, like racism and poverty.
            We need a drug policy that recognizes the role that racism, poverty and the lack of opportunity play in fostering drug use and our responses to it and works to resolve them.  Medicalization mutes racism and inequality and then blames individuals for not being able to overcome them.  Instead of isolating and blaming those who use drugs, we need to restore communitarian responses that will help all people lead lives of dignity.
            In addition to working towards building strong, vibrant communities where everyone has the opportunity to thrive, we need a drug policy that rationalizes our approach to substances, not arbitrarily judging them legal or illicit, but helping individuals understand the real risks and benefits each poses. To the extent that we want to control and limit the use of some substances, we should focus on the real harm they cause, not our irrational and/or racist fears about particular substances.  Imagine a drug policy where there are not arbitrary lines between bup, Oxycontin, methadone and heroin --  making some demon drugs that lead to incarceration and some cures to that same addiction.  Imagine a drug policy that does not draw a distinction between “medical” marijuana and “illicit” marijuana but simply explains the benefits and risk of marijuana use and trusts that people can make informed decisions about their own embodied experiences and health.  We believe that most people can moderately consume alcohol, Oxycontin, and Prozac without the threat of arrest.  Why not some opioids?  Imagine instead of stigma, fear, ambiguity and confusion, we offered information and support for whichever substance (or no substance at all) helps people.
            The features of buprenorphine that helped people in my study the most were its legality and availability, the autonomy it gave it them over their own drug use and treatment, and its relative freedom from stigma.  These qualities can and should guide or drug policies.  But our drug policies must also include a commitment to understanding and dismantling systemic forms of oppression, racism, and inequality and to challenging neoliberal efforts to undermine communitarian responses to social problems.
Image source: Students for Sensible Drug Policy (

Thursday, February 9, 2012

Daily Show's Asaf Mandi Reveals Drug Testing Hypocrisy

In case you thought we were done using drugs to stigmatize poor people, check out this great video from the Daily Show illustrating the hypocrisy of proposals, like the one in Florida, to require a urine tox screen to get public assistance.

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Sunday, February 5, 2012

Mass Incarceration

I recently worked on a literature looking at some of the great work being done trying assess the impact of our policies of locking up millions of Americans.  I thought I would share it here.

The Scope of the Problem
The scale of incarceration in the U.S. is without historical precedent. More than 1 in every 100 adults (2.3 million people) in the U.S is behind bars. The proportion of Americans incarcerated has increased by 300% since 1980, and the U.S. now has the highest incarceration rate in the world (Pew Charitable Trusts, 2010).  In New York under the Rockefeller Drug Laws, the incarceration rate quintupled from 73 prisoners per 100,000 resident in 1973 to 386 per 100,000 in 2007 (Drucker, 2011).  In 2010 alone, more than 437,000 New Yorkers were arrested.  The vast majority of these arrests were for “quality of life” offenses.  For instance, in the South Bronx, only 3% of convictions were for felonies (Drucker, 2011).  Nonetheless, even brief encounters with the criminal justice system can have profound consequences, such as the loss of jobs and housing, disruptions in school and health care, deportation, and losing custody of children.  While the toll on individuals is profound, what is often lost in discussions about incarceration and reentry is the cumulative effect and burden mass incarceration places on entire communities.
The impact of mass incarceration is concentrated in communities of color.  If whites were incarcerated at the same rates as blacks, more than six million men -- 5% of the male working age-population -- would be in prison (Wakefield, 2010).  One in three young Black men (ages 20-34 years) without a high school diploma is incarcerated (Pew Charitable Trusts, 2010).  An analysis by the Justice Mapping Center demonstrated that the vast majority of men sent prison come from a relatively few neighborhoods in New York City; fourteen community districts account for more than 50% of the men sent to prison from NYC, though they account for only 17% of the total adult male population (Justice Mapping Center, undated).  In some neighborhoods, like East Harlem, one in every 20 adult men is in prison (Moore, 2007).  These high rates of incarceration affect the same communities already dealing with soaring rates of unemployment, poverty and health disparities (Health disparities in New York City, 2004; Travis, McBride, & Solomon, 2005).
Some have suggested that these high rates of arrest and imprisonment in urban communities, amount to mass forced migration with concomitant population destabilization representing losses on the scale of epidemics or terrorist attacks (Drucker, 2011; Drucker, 2002; Thomas & Torrone, 2008).  Virtually all the people we incarcerate will be released and return to our communities.  In addition to the stigma of a criminal record and the damage to social networks that occurs during incarceration, many people reentering the community from prison face significant legal barriers to accessing health care, public housing and employment opportunities (Willmott & van Olphen, 2005; Iguchi, M.Y., 2005; Golembeski & Fullilove, 2008; Moore & Elkavich, 2008).  Rather than helping them fulfill their responsibilities to their families, contribute to their communities and the economy, and make restitution to their victims, our current system almost insures that they will fail at each of these.  In doing so, we weaken the health and economic vitality of some of our most fragile communities.  While the specific mechanisms by which incarceration and reentry from prison affect communities are poorly understood, there is increasing evidence that incarceration, especially when concentrated in particular communities, hurts the economy, destabilizes families and social networks, contributes to poor health, and decreases public safety.
Mass incarceration diminishes earning power and the labor force, exacerbates social inequality and poverty, and diverts resources from communities that need them most.
Before the recession, studies suggested that the unemployment rate for formerly incarcerated people one year post-release was as high as 60% (Drucker, 2011).  According to a report by the Pew Charitable Trusts, serving time reduces hourly wages for men by 11%; by age 48, the typical former inmate will have earned $179,000 less than if he had never been incarcerated (Pew Charitable Trusts, 2010).  Unfortunately, these ill effects extend to the 2.7 million children who have a parent behind bars.  Sixty-eight percent of incarcerated fathers were the primary source of income for their families (Travis & Waul, 2004).  Family income averaged over the years a father is incarcerated is 22% lower than the year before the incarceration, and family income remains 25% lower than it was even in the year after the father is released (Pew Charitable Trusts, 2010).  Moreover, parental income is a strong predictor of a child’s future economic mobility, suggesting that the economic impact of incarceration is multi-generational.  
Because incarceration is concentrated among men of color from particular neighborhoods, the economic impact in some communities is profound.  A labor force analysis that takes incarceration into account found that younger, less educated Black men are more likely to be incarcerated then employed (Pew Charitable Trusts, 2010).  Nationally, “the lost earnings associated with incarceration are equal to 6 percent of the total expected Hispanic male earnings and 9 percent of the total expected black male earnings (Pew Charitable Trusts, 2010: 12).”  Overall, increases in incarceration since 1980 have reduce the activity of young black men in the labor force by 3-5% according to one estimate (Clear, 2009). 
Based on analysis of national social science databases, Western and Pettit (2010) found that incarceration has become the core dynamic sustaining socio-economic inequality between whites and blacks because of the way it disproportionately disadvantages black men in terms of employability and lifelong earnings, while increasing single-parent households in communities of color (Clear, 2009).  Another economic analysis found that mass incarceration may help explain why poverty increased during the period of economic growth between 1980 and 2004; the authors concluded “had mass incarceration not occurred, poverty would have been decreased by more than 20%... this translates into several million fewer people in poverty had mass incarceration not occurred  (DeFina and Hannon, 2009).”
Finally, mass incarceration impacts the economy through the diversion of resources.  An estimated $70 billion is spent annually on corrections.  Researchers have identified several “million dollar blocks” in Brooklyn in which more than a million in taxpayer dollars is spent annually to incarcerate residents from each block (Spatial Information Design Lab, undated).  The reinvestment of these resources into these same neighborhoods could go a long way towards reducing crime, preventing incarceration, and rebuilding community.
Mass incarceration impacts the health of individuals and communities
Mass incarceration affects the health of communities in two primary ways.  First, research suggests that our current drug interdiction and deterrent strategies – which are concentrated in communities of color -- have serious consequences that adversely affect the health of communities, including increased violence (Mosher, J.F. and K.L. Yanagisako, 1991; Haden, 2004) and higher rates of HIV and other blood borne disease (Haden, 2004).  Although illegal drug use is spread throughout society, the harm from drug use and the war on drugs is not evenly distributed; drug-related overdose and homicide, traumatic injury, HIV/AIDS --  are all higher in communities of color and where income inequality is greatest (Mosher, J.F. and K.L. Yanagisako, 1991; Galea, S. and D. Vlahov, 2002).  Moreover, the criminalization of non-violent offenders contributes to the stigmatization of drug use, which in turn, discourages drug users from seeking needed services and negatively impacts their physical and mental health (Ahern, J., J. Stuber, and S. Galea, 2007; Young, M., et al, 2005).  Once convicted, those reentering the community from prison or jail do so facing a set of barriers that puts their health in extreme peril --  including leaving prison without Medicaid or other health coverage, the inability to secure housing or employment, and often returning to communities already challenged by poverty, poor health, and a lack of resources.
Second, as suggested above, incarceration contributes to existing social and economic inequalities, which are key determinants of health (Hathaway, 2001).  Incarceration disrupts social networks, undermines sources of social and financial support, impedes education, and contributes to homelessness and poverty --  all factors associated with poor health outcomes (London and Myers, 2006). 
Mass incarceration diminishes family and community stability and cohesion
Incarceration has profound collateral consequences for families and communities.  Nationally, 10% of all minor children have a parent in prison or jail or on probation or parole (Travis et al., 2005).  Studies suggest that parents try to stay in touch with their children but have difficulty because of distance, visiting rules, and restrictions on phone calls (Travis et al., 2005).  While the negative impact of incarceration on children can be mitigated by a number of factors, reviews of the literature suggest that the incarceration of a parent is associated with low self-esteem, depression, emotional withdrawal, disruptive behavior at home and school, poor school performance, higher rates of delinquency and arrest, illegal drug use, underemployment, and increased risk of abuse and neglect (Clear, 2009; Travis & Waul, 2004; Travis et al., 2005).  Most children are cared for by the remaining parent or placed with other family members when a parent is incarcerated, but 10% of children whose mothers are incarcerated and 2% of children whose father are incarcerated end up in foster care (Travis & Waul, 2004). 
This kind of disruption to families and social networks, when concentrated in particular communities, begins to undermine the social and family support structures that are especially vital in low-income communities (Drucker, 2011).  Increasingly, research shows that incarceration weakens ties to community, family, work and civic engagement (Willmott & van Olphen, 2005).  Todd Clear and colleagues (Clear, Rose, & Ryder, 2001) have done interesting analyses of how the spatial concentration of incarceration destabilizes informal networks of social control.  Their analysis suggests that stigma, the financial impact of incarceration, the identity of neighborhoods as ‘problem places,’ and the disruption of social networks are the main mechanisms by which incarceration impacts families and neighborhoods for years.   In a study looking at the spatial concentration of incarceration in particular New York City neighborhoods noted that the ability of communities to address the social and economic factors that contribute to incarceration diminishes as the size of the ex-inmate population grows (Fagan et al, 2004).  Golembeski and Fullilove note: “[I]t is difficult to estimate how and to what degree residential instability leads to decreased community stability… each distinct neighborhood faces a unique set of challenges that depend on the population count, demographic distributions, and health needs of residents who have been incarcerated (2008: S189).” 
Mass incarceration may be threatening public safety in some communities
The relationship between incarceration and crime is complex.  But recent scholarship suggests that we may have reached a tipping point where the negative effects of large-scale imprisonment are outweighing any reduction in crime because the large numbers of people cycling in and out of prison is destabilizing neighborhoods (Clear, 2007; Drucker, 2011; Mauer, 2005; Western and Pettit, 2010). Scholars argue that possibility of improved public safety through incarceration has been exhausted (Western and Pettit, 2010) and that we have now entered an era where mass incarceration is self perpetuating (Drucker, 2011).  The cycle of incarceration is thought to affect community safety through several pathways:  1) removal of residents changes the capacity of social networks to resolve problems and enforce community norms, and it weakens neighborhood ties; 2) removal of family members creates disruptions in home life that may lead to delinquency; 3) the imprisonment of huge numbers of young men concentrated in particular communities has grown to become a ‘bedrock experience’ that shapes families, businesses, institutions, and social groups in profound ways; and 4) the reentry from jail and prison of large numbers of individuals who have high needs but few resources strains already overburdened neighborhoods (Clear, 2007).  Moreover, the impact of policing in communities of color may be reducing confidence and trust in the justice system among Blacks, impeding the effectiveness of law enforcement (Mauer, 2005).
Finally, public safety more broadly conceived recognizes that crime is not the only threat to safety.  Family instability, poor health, substandard housing, and unemployment all threaten the health, welfare, and stability of communities.  As Western and Pettit explain: “Public safety is built as much on the everyday routines of work and family as it is on police and prisons (2010: 18).”

Ahern, J., J. Stuber, and S. Galea.  (2007). Stigma, discrimination and the health of illicit drug users. Drug Alcohol Depend, 88(2-3): 188-96.

Clear, T. (2007).   Imprisoning Communities: How Mass Incarceration Makes Disadvantaged Neighborhoods Worse. New York: Oxford University Press.

Clear, T. (2009). The collateral consequences of mass incarceration. Paper presented to the School of Criminology and Criminal Justice, Arizona State University, April 3, 2009. 
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Mauer, M. (2005). Thinking about prison and its impact in the 21st century. Ohio State Journal of Criminal Law, 2:607-618.
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Mosher, J.F. and K.L. Yanagisako (1991). Public health, not social warfare: a public health approach to illegal drug policy. J Public Health Policy, 12(3): 278-323.
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