A Cruel Set-Up

People incarcerated in Alabama prisons are routinely dying from drug-related causes. So why are we locking up people who suffer from substance use disorder in deadly, drug-infested prisons?

By Leah Nelson

Note to readers: To protect the identity of the currently incarcerated man profiled in this story, names and minor identifying details have been changed. 

ALABAMA (July 2021) – In a drab conference room off the courtyard at a rural Alabama work release facility, “Ben” took stock of his situation. “Eight years of my life for basically hurting myself and my family, emotionally. Eight years for a crime with no victim,” he said of the time he’s spent in prison. “It seems excessive. I know people that hurt people and got less time than I did.”

That’s the heart of the matter for Ben and the thousands of other people incarcerated in Alabama’s deadly, drug-infested prison system for drug crimes and the petty offenses that go hand-in-hand with substance use disorder. “I’m not like a criminal at heart. It’s all just personal drugs,” he said. “If I could get the addiction out of my life I wouldn’t be a criminal.”

Turn back the clock a few decades to when he wasn’t, yet. Turn it back to the early 1990s, when Ben was a little boy growing up in a small north Alabama town, whiling away the hours with his across-the-street neighbor “Jim.” 

“We pretty much hung out every day from when the sun come up till it got dark. Riding bicycles, playing in the creek, stuff like that,” Jim said in an interview. 

When they got a little older, the boys started mowing lawns together. Over time, they built a stable clientele and earned pretty good money, Jim said.

Then came the accident. Ben and his cousin were messing around with gasoline and a paint can, and something exploded.

Ben, who was around 15 at the time, sustained severe burns. Doctors put him on a morphine drip and sent him home with a 30-day supply of Percocet. 

And nothing was ever the same again.

Nearly a quarter of a century later, Ben and Jim’s lives are a study in contrasts. Jim, now 38, went to community college, got a degree, married, had two children, and started a professional landscaping business. He used some of his earnings to buy a house from the family of a woman whose lawn he used to mow with Ben. He lives next door to Ben’s parents.

Ben, 36, is incarcerated at a minimum-security prison in rural Alabama.

Alabama Appleseed has been in touch with Ben for well over a year, ever since his parents took the drive from their north Alabama hometown and showed up on our front porch, hoping we could help free their son. Ben, they told us, is a good man who made some mistakes when he was in the throes of addiction. Now, they’re worried about his safety in light of the United States Department of Justice’s allegations of unconstitutionally violent conditions in nearly all of Alabama’s prisons, and horrified at the idea that he could be an old man before he is free.  

There is no question that Ben has broken Alabama law. Since roughly 2006, he has been convicted of multiple offenses, mostly drug possession and petty theft. None of his offenses were violent or caused physical harm to a victim. His most serious crime was unlawful manufacture of a controlled substance, which he was convicted of twice, each time after police found him in possession of precursor chemicals and supplies to set up a small-time operation to make crystal methamphetamine for personal use.

Ben’s convictions are all connected by the thread of addiction, a disease whose onset was prompted by the 30-day prescription for Percocet he received when he was a child. His 26-year sentence, bloated by Alabama’s unforgiving Habitual Felony Offender Act, subjects him to years in dangerous prisons where overdoses and other drug-related deaths are so prevalent that reporters struggle to keep up with their numbers.

So when it comes to Ben, the relevant question is not how many chances he has had, but rather what those chances have meant – and what should be done now. Given that substance use disorder is a disease, is a lengthy sentence in Alabama’s deadly, drug-infested prisons really the best medicine for someone like Ben? 

In conversations that began just before the pandemic and picked up in July 2021, we put that question to Ben himself.

Thin, fair, and bespectacled, Ben has the bearing and demeanor of an Alabama man who was taught his manners: Yes ma’am and no ma’am; eye contact when he speaks. He is unassuming and self-deprecating, slightly embarrassed to be the center of attention.   

Even so, his response to our question about whether prison was the right place for someone like him was loud and clear. “A drug addict and they’re sitting in a horrible environment, sometimes traumatizing, and you’re in a state of mind and a horrible place – that drug is your only friend. It’s your relief. It’s very tempting,” he said. “When you’re in active addiction it’s like you’re already in prison – and then you get put in prison. It’s like prison within a prison.”

“What good is it throwing someone in prison and they’re just going to hurt themself?”

Anatomy of an addiction

Ben grew up in a deeply conservative north Alabama county where it is illegal to sell alcohol in all but a few municipalities. His parents provided a middle-class childhood for their two children, Ben and his older sister “Faith.”

In 1999, the year Ben turned 15, opioid prescriptions were on the rise in the United States. OxyContin, a potent reformulation of an older drug, had been introduced three years earlier, and its manufacturer, Purdue Pharma, had sales representatives across the country telling doctors that it was safe, responsible, and compassionate to prescribe their new drug to manage all kinds of pain.

Crucially, pharmaceutical representatives told doctors that patients who suffered legitimate pain – the pain associated with severe burns like the ones Ben sustained, for instance – were unlikely to become addicted to prescription opioids.

It is now common knowledge that OxyContin and other opioid medications, including the Percocet Ben was prescribed, are both addictive and potentially deadly. But the damage is done. According to the Alabama Department of Mental Health, between 2014 and 2020, 20,122 Alabamians who received treatment for opioid use disorder first used opioids at age 15, the same age Ben was when he received his first prescription. Overdose deaths related to opioid use are high and rising, with 581 opioid-related deaths in 2020 alone, according to the Alabama Department of Public Health.

Lax prescribing rules and the false notion that people experiencing pain were unlikely to become addicted meant that pills were readily available on the black market. In 2006, the most distant year for which the Centers for Disease Control maintains data, opioids were dispensed at a rate of more than 112.5 prescriptions per 100 residents in the cluster of north central Alabama counties where Ben spent his time. Walker County, for instance, saw dispensing rates of a staggering 304.11 prescriptions per 100 residents that year.

Those numbers, though they may have been somewhat lower in the early 2000s when Ben’s addiction first became entrenched, meant it was easy for teenaged Ben to find pills once his prescription ran out.

“Several people whose grass I would cut, and shrubs, who were as they say ‘cool,’” would pay with pain pills,” Ben said. “I had one customer who couldn’t hardly walk so I’d get her groceries and help her out [at home] and she’d say, ‘Go over and get some of my prescriptions’” as payment.

“[ADOC’s] failure to prevent the introduction of illicit substances leads to deaths by overdose. … ADOC does not accurately identify or classify every death caused by overdoses.” –U.S. Department of Justice, May 2021

Alabama’s prisons are death traps. Alabama Appleseed has identified, by name, 89 people who have died violent, preventable deaths from homicide, suicide, or drug overdose over the last six years while in the custody of the Alabama Department of Corrections.

Drug-related deaths seem to have risen sharply over the last year. Observers of the system estimate that at least 10 men died in ADOC custody in July 2021 alone, most of them after apparent overdoses.

“Although ADOC has not allowed visitors into Alabama’s Prisons for Men since March 2020 pursuant to COVID-19 restrictions, prisoners continue to have easy access to drugs and other illegal contraband.” –U.S. Department of Justice, May 2021

It took Ben’s parents a few years to fully understand what was happening. Shortly after Ben graduated from high school, they confronted him. He admitted he needed help, and they put him in a 28-day rehab. 

“He didn’t stay,” his mother said. “Then as soon as he got out he went back on it. And it seemed like every time he went to rehab, he’d come out worse than he went in.”

As Ben got older, his condition became more complicated. Like many people with substance use disorder, Ben was a polysubstance user, meaning that he used several different types of illicit substances. He described the Percocet he was prescribed as a teen almost like a demon: it “woke up whatever was in my DNA,” he told Appleseed. 

Ben also experiences depression and anxiety, common co-occurring disorders in people with substance use disorder. In conversations, he cited his mental health struggles as often as his substance use as a source of anguish. “I can’t even really tell you the last time that I really felt happy. Ever since I woke that thing up inside of me when I was 16 or so, it’s just been miserable,” he said. “Ever since they put me on those pain pills and woke that thing up inside me it’s been hell. It’s been meaningless.”

When he was in his early 20s, Ben’s friends introduced him to crystal meth. He also misused benzodiazepines and cannabis. He drifted further away from his parents and from his old lawnmowing partner Jim, who said it seemed like Ben “disappeared” into substance use.

If little about Ben’s childhood would suggest he would find himself trapped in a cycle of addiction, much about his family history does. Genetics do not determine addiction, but “genetic and environmental factors interact to determine how vulnerable, or likely, you are to developing a substance use disorder,” according to Dr. Maria Mavrikaki, an instructor at Harvard Medical School. 

Ben’s uncle “Jeff” has battled substance use disorder for much of his adult life. Jeff, who is Ben’s mother’s brother, now lives and works at a Christian ministry that emphasizes recovery through faith and work. Jeff told Appleseed he has an “addictive personality” and that he used alcohol to give him “courage” and overcome anxiety. He also noted that alcoholism ran in his family.

Ben’s older sister Faith succumbed to it. After battling alcohol use disorder for years, Faith died from cirrhosis of the liver at the age of 35.

Ben’s parents, he observed, had “two sick kids. One chose something that was legal. I chose everything that was illegal,” Ben said.

“Everything was going good for a little while”

The fact that Ben’s addiction prompted illegal activity eventually caught up with him. Alabama does not have a publicly available repository of all criminal records, but as early as 2006, he faced charges in connection with his substance use disorder. Alabama Appleseed was unable to track down records showing the specific charge, but in a letter apparently written to a municipal court in May 2007, a lawyer representing Ben explained that Ben was behind on fines and costs because he had been in rehab and then a halfway house.

The attorney’s letter included certificates of completion from two programs, as well as a letter from Ben’s then-employer, who praised his “aptitude, willingness, and shear [sic] hustle” and said he planned to keep him on as a long-term employee. “[Ben] impresses me as a fine young man with a good raising,” the employer wrote. “He is trustworthy, honest and dependable. I consider him a wonderful find, and a definite asset to my business.”

It is unclear how long this period of sobriety lasted. In Sept. 2008, Ben was arrested in his hometown and charged with third degree burglary. In Feb. 2009, he was sentenced to two years on probation and ordered to participate in CRO, a post-adjudication diversion program intended to connect people with substance use and recovery services. 

It didn’t work. Ben was arrested again in Oct. 2009 in another county, and again, in June 2010 in his home county. According to the police report filed in connection with the 2010 arrest, the officer pulled him over for making an improper lane change, ran his name, found an active warrant, and got permission to search the car. Inside, he found a syringe, coffee filters, a lithium battery, a Ziploc bag containing ephedrine, and a cup full of Coleman fuel. Ben was charged with unlawful manufacture of a controlled substance in the second degree, a Class B felony. 

While awaiting trial, he went to a residential treatment program in south Alabama. He pled guilty to the manufacturing case in Feb. 2011 and received an eight-year suspended sentence.

At the residential treatment program, “Everything was going good for a little while,” Ben remembers. He and a fellow resident he’d befriended decided to room together after they completed the program. 

That was a mistake.

His roommate, Ben told Appleseed, was a well-known addiction specialist who confessed to him that even as he made speeches about the dangers of substance use, he was often under the influence himself. (Appleseed has been able to confirm that a man of the same name and with the same year of birth as Ben’s roommate was indeed a prominent addiction specialist.) 

Once they were living independently, Ben and his roommate fell back on old habits and began producing methamphetamine for their own use. In Oct. 2011, Ben said, he was on the way home from dropping his roommate at an Alcoholics Anonymous meeting when police pulled him over and searched his car, and eventually his home. Both he and his roommate were arrested and charged with unlawful manufacture.

This new arrest prompted his probation to be revoked. Ben went to jail.

In court, Ben recalled, the prosecutor played down the likelihood of a long sentence. But Ben had enough felonies on his record to qualify as a habitual offender, exposing him to a significantly harsher sentence than anything he had previously faced. Terrified of what might happen at a trial, Ben’s mother begged him to plead guilty and take a deal. Against his better judgment, he gave in. The judge sentenced him to 26 years, to run concurrent with his prior sentences from north Alabama. 

“I’ve seen people in class under the table injecting drugs in the prison in the drug treatment class.”

Like many people who are incarcerated in Alabama, Ben’s sentence required him to receive addiction treatment behind bars. According to ADOC, 75 to 80 percent of incarcerated Alabamians have histories of substance use, making the prison system the “largest substance abuse program within the state of Alabama.” ADOC’s 2019 Annual Report says that 2,861 incarcerated individuals completed some form of substance use treatment that year.

ADOC is compensated well for providing this service. In Fiscal Year 2019, the most recent year for which an annual report is available, the agency took in $1,923,860 in County Drug Conviction Fees. On top of that, almost 74% ($673,189) of the $912,563.20 spent on state and federal grant funded projects went toward Residential Substance Abuse Treatment (RSAT). Another 7% ($64,033) went toward “purchas[ing] personal protection equipment for ADOC agents to use when handling contraband and dangerous narcotics” that made their way into the supposedly secure facilities. 

But despite all that money – roughly $2.5 million in 2019 – addiction treatment in ADOC is patchy and inadequate. Ben, for example, was assigned to a prison that did not even offer the treatment program he was ordered to take.

The judge who sentenced Ben to 26 years in prison required him, as a condition of his confinement, to participate in ADOC’s Substance Abuse Program (SAP) as well as its six-month Crime Bill program. But Elmore Correctional Facility, where Ben was incarcerated, did not offer Crime Bill, leaving him unable to meet the conditions of his sentence. 

In fact, it is not uncommon for Alabamians whose sentences require them to participate in a given program to be imprisoned in facilities where that is impossible. To get a better understanding of how that happens, Alabama Appleseed spoke with Hayden Sizemore, a former ADOC classification specialist who is now an attorney.

Sizemore explained that classification specialists are alerted when a person’s incarceration is supposed to include conditions like participation in SAP or Crime Bill. She said those conditions are noted in the summaries they prepare for the central review board. But other factors, including the person’s risk level and how many beds are available at any given facility, may take priority over conditions set out in a judge’s order. And even if the person is placed at a facility that offers the programming they are required to participate in, Sizemore said, it often falls to that person to alert corrections staff that they have been ordered to engage with certain programs and insist that they be offered access.

The system, Sizemore said, is driven by “logistics,” not court orders.

“Judges think they’re doing the person a favor, ‘I’m going to sentence you to this treatment to make sure you get it,’” Sizemore said. But “[w]hen it comes down to it, you have to have somewhere to put them,” even if that means a facility that doesn’t offer them what they need. 

In a letter dated Sept. 24, 2013, Ben asked his parents to contact ADOC and tell them he needed to be transferred in order to comply with the judge’s order. 

“I’m trying to get transferred to a camp that has Crime Bill. I have been ordered to Crime Bill by a judge. The camp I’m at does not offer Crime Bill, and this camp won’t put me in for transfer until February. I want to be put in for transfer now,” he wrote. He said he hoped to be transferred to Limestone, Bullock, or Ventress prisons and asked his parents to Google each to ensure that Crime Bill was offered there. 

Ben was doing his part to earn parole or transfer to Community Corrections, but if he failed to complete this required treatment, those requests would most likely be denied.

 “I am grateful for the raising you guys have given me,” he wrote to his parents. “There are so many people here who don’t have any kind of raising and I’m glad I’m not one of them. I can handle this and I don’t want you to worry about me. You have plenty else to worry about besides me. I’m fine.”

The did have other things to worry about. Ben’s older sister Faith, their only other child, was dying. In Aug. 2013, the medical director for the hospice where Faith was receiving care wrote a letter to a judge saying that Faith “has requested that her brother be nearby in case of her probable impending death. She has a terminal diagnosis of Cirrhosis and is in the end stages of the disease process. According to Medicare/Medicaid guidelines for Hospice criteria, the patient has approximately six months or less of life expectancy.”

Faith died two days after Christmas in 2013 at the age of 35. By then, Ben was at Limestone Correctional Facility and on track to complete Crime Bill. Faith visited him about two weeks before she died. 

Grieving for his sister, Ben remained committed to recovery. Treatment seemed to be back on track – until suddenly, it wasn’t. He participated in Crime Bill at Limestone for all of four weeks before the program was shut down, he recalled.

ADOC transferred him to Bibb Correctional Facility, notorious for being more violent than Limestone. “It was a mess. Blood everywhere, people stabbed left and right,” Ben told Appleseed. 

He was in the Crime Bill dorm, but drugs were abundant. “I’ve seen people in class under the table injecting drugs in the prison in the drug treatment class.”

That wasn’t all. Ben has seen men’s faces melted from a concoction of depilation cream and baby oil their enemies microwaved and put on their skin. He has seen men overdose. He saw a man with a syringe stuck in the roof of his mouth. “At Elmore, I saw a guy get his throat cut coming out of the chow hall … over $3 he owes.”

Indeed, in many ways what is remarkable about Ben’s experience is just how unremarkable it is in the context of Alabama prisons. Illicit drug use in ADOC facilities is at crisis levels. The U.S. Department of Justice (DOJ), which is suing the Alabama Department of Corrections for operating unconstitutionally cruel and dangerous prisons, put it this way: “The failure to prevent the introduction of illegal contraband leads to prisoner-on-prisoner violence. For example, the use of illicit substances, including methamphetamines or Fentanyl and synthetic cannabinoids, is prevalent in Alabama’s Prisons for Men. Prisoners using illicit substances often harm others or become indebted to other prisoners. The inability to pay drug debts leads to beatings, kidnappings, stabbings, sexual abuse, and homicides.”

In its Amended Complaint filed in May 2021, DOJ further alleged that “ADOC does not accurately identity or classify every death caused by overdoses.” It observed that even during the pandemic when visitors were disallowed, “prisoners continue to have easy access to drugs and other illegal contraband.”

The results of ADOC’s failures, DOJ contended, are overdoses, deaths, and violence pursuant to drug debts. In one horrific instance in April 2017, “a Bibb prisoner was stabbed multiple times by another prisoner while sleeping. His attacker stated that the victim owed him a drug debt, so he ‘got it in blood.’”

Despite all this, Ben avoided drug use during his stays at Elmore, Limestone and Bibb. He completed the programming to which he had been sentenced, stayed out of trouble, and in 2018, he was granted parole. He moved to a new town, got a job, and started dating. But he had no support, no community to help him stay sober. Then he got a corneal infection at work which kept him home for months. 

Being stuck inside his own head, sick, with nothing to do, was poisonous for Ben. It triggered anxiety and depression, his old demons. “I had feelings. I needed them to go away,” he said. So he started using drugs again.

In 2019, Ben was arrested with Xanax and Klonopin. He was charged with two felonies and pled guilty. 

Seven years surrounded by violence and drug use in prison did not heal Ben. Prison did not vanquish his disease. And less than a year after his release, following offenses that harmed no one but himself, he was sent back to the same system, although this time in the wake of specific findings by the federal government that ADOC leaders fail repeatedly to prevent illicit substances from entering their facilities.

“It’s really hard on drug addicts to do nothing and be surrounded by temptation. It’s cruel.”

The court sentenced him to 104 months in prison for his two new felonies. ADOC sent him to minimum-security prison that sends people who are incarcerated out into the community to work but keeps them in dorms at night. 

At least the work release facility is less violent than other prisons he has been housed in. Before the pandemic started, he participated in as many classes and programs as possible, trying to keep himself busy, clean, and focused. The pandemic shut everything down. To keep them occupied, the incarcerated men were given access to tablets loaded with podcasts and movies. The morning Appleseed met with him in July 2021, Ben had been watching “Texas Chainsaw Massacre.” 

“Being bored, nothing to do. Spinning my wheels. I feel like I just wasted a whole year of my life, resisting temptation, and it’s cruel,” Ben told Appleseed in July 2021. “It’s just a cruel set up.”

He gave into temptation during the dark, terrifying 14 months of lockdown, accumulating his first-ever disciplinary infraction. He failed a drug test after taking illegal drugs that had been smuggled into the prison.

In the courtyard at the work release center, someone set up a Havahart rodent trap. The trap was sitting in the corner of the courtyard when Alabama Appleseed visited on July 1, 2021. Presumably, whoever set the trap hopes that the raccoon or whatever unsuspecting creature found itself stuck in the prison courtyard will wander into the trap so it can be taken to a safer environment and set free in a place where it will thrive.

With Covid again bearing down on the state, Ben remains trapped inside with no classes, no programs, and a disease that thrives in idleness.

Ben is eligible for parole in Jan. 2022. Despite his disciplinary infraction, he is a good candidate for release, though Alabama’s parole board is granting releases at an historically low rate.

Asked what it would take for him to succeed outside prison walls, Ben said that whatever else he does, he desperately wants to work – any job that would give him a sense of purpose, no matter how menial. The closest he’s been to happy in the past several decades was when he was working, he told Appleseed. “I was going to work and I was staying clean and I was working at a chicken plant – which is a bottom of the barrel job, but I was clean. I was accomplishing something.”

He wants to live near his family. He wants to be safe from the violence that has been a constant threat in ADOC facilities. He wants to participate in a recovery community that will keep him away from the drugs that are readily available to him in prison.

“Prison is a dangerous place,” he told Appleseed. “You come in here with a drug problem – and you might get killed.”