Some people see addiction as a moral failure, others see it as a choice, and still others see it as a stand alone disease. This is a case where a one-size-fits-all answer does not exist. The root cause of addiction is changes to the brain, but here too there isn't a single answer. Depression and other mental illnesses seem to play a major role as does taking anti-depressants and ADHD medications. People who are so unhappy in their lives are willing to risk everything to find an escape route.
Clearly, prison/jail does not really help people who are just your run-of-the-mill addicts. Not much seems to help these people until they WANT to help themselves. Forcing people in to rehab is just a waste of everyone's time and money. The states and Feds have limited funds to provide housing, food, and medical care to people. Is it really fair to give so much to people who have no desire to be "sober" when you have a poor hungry kids with a very sick parent who cannot afford their medication?
At the end of the day, most addicts did choose to do drugs or drink. Most did so to dull the pain (hell) they perceive. Let's help them fix their living hell by addressing what is causing it be it mental illness, real untreated pain, or side effects from Rx meds.
1
"...all define addiction as a chronic, relapsing brain disorder that, like diabetes and heart disease, is caused by a combination of behavioral, environmental and biological forces."
While I happen to generally accept the thesis of this opinion piece, this sentence reveals sloppy editing. The analogy may well be true of type 2 diabetes, but it is NOT true of type 1 diabetes. The word diabetes in the sentence should have been properly qualified as type 2. Type 1 diabetes is an autoimmune disorder that has no causality from behavior or environmental forces. Lumping the two types of diabetes into a single disease is simply wrong and damages the perception of people suffering from type 1 diabetes.
2
It is time for the United States to legalize all drugs except possibly anti-biotics. The war on drugs is not a war on drugs but on drug users. We have been fighting the war for 70 years without success and millions have been injured in violence and poisoning from poor quality drugs. But if we don't want to legalize all drugs, I ask that the rich and upper middle class and their children be given the harshest punishments and treatment. Rush Limbaugh should have spent 10 years in prison for his offenses. Attorney General Eric Schneiderman should be prosecuted for prescription drug abuse as well as distribution. If Oprah has drugs at a party she's giving, she should be arrested. If the drug laws are going to be enforced, they should be enforced against the most powerful members of society first. But then I say, we should end the drug wars and legalize all drugs.
1
..thanks to the NY Times for such an insightful article. We must realize addicts are not criminals - they need help, not incarceration. We need to change the laws to provide much needed therapy for these individuals - locking them up is a crime.
3
It is absurd to put a sick person in prison or jail. There is little treatment for them there and drugs flow through the system.
As the developer and director several treatment programs, I can attest to the fact that drugs (even alcohol) change the brain. It can take several years for the brain to return to its best functioning. This is one reason that addicts make bad decisions and relapse. In fact, a relapse starts long before an addict uses the drug again. Using is the evidence of relapse, but not the cause.
Meanwhile, we pour money into prisons with cages rather than into prevention and treatment. Yet punishing people for their illnesses has never worked. No wonder the war on drugs is a failure.
1
According to American law and due to the opioid crisis 50% of the American adult population should be in jail.
The judicial system must change rules on these drug issues.
2
Of course prisons “deny opioid addicts access to medication-assisted therapy, or MAT...that can relieve opioid cravings...Most addiction specialists say MAT is far and away the most effective treatment for opioid use disorder.” Hazelden began using buprenorphine only in (and patients who did use it were not considered to be “sober”) 2005 or 06, a drug that so successfully treats cravings - for opioids, alcohol, food, anything that arouses the “opioid receptors” in the brain - it should be free to anyone who needs it. But the Prison-Industrial Complex needs its money. So does the Rehab-Industrial Complex.
2
More numbers, please. A lot is not a number. In at least two cases of which I am aware the user (drugs in one case, alcohol in the other) did not give up the drugs during rehab but managed to get clean and stay clean in jail in one case... and after rehab and jail in the other. In the second case the woman is in her 60's. Focused rehab/jail sentences-- removing the addicted person from his habitual environment -- friends and family (not always so helpful) may work. Obviously, jail time should correspond to treatment time... otherwise a total waste. I am proposing a special kind of incarceration for the addict. (Separate from the Wall Street types.... just had to add that ... so the injustice of the system is clear. People who more or less legally hurt others go scot-free and are rewarded... Those who mostly hurt themselves are caused pain.
1
If addiction is a disease, why is there no cure or anything close to a cure? Let's admit it is not a disease and start over. AA doesn't work long-term for most people, and rehab is a joke (except to the people making money off it). I say this as someone who is very close to three sufferers, one of whom has stayed away from his drug of choice successfully for 50+ years. The jury is still out on one of the others, and the third is beyond hopeless.
3
The Editorial board poses a misleading question, "If addiction is a disease, why is relapsing a crime?" as the title of this article.
If this article were about overeating or videogame addiction there would be nothing to contend. However, this article focus on the opioid crisis, which makes for an obvious response.
Relapsing is a crime because illegal narcotics are only available at an enormous cost to society. From the US Soldiers and Marines in Afghanistan who lose their lives to the Taliban defending their illegal drug trade to the children killed by stray bullets in clashes over distribution rights, the casualties of our relapses are too serious to ignore.
I agree, imprisonment may not be an effect deterrent for addicts, but it is infuriating to me that this article discusses the addicts suffering without mentioning the suffering inflicted on others as a result.
3
I'm not 100 percent in the camp that addiction is always a disease, and I'm not sure it's useful to have addiction defined as such. Disease indicates that one has no choice, no mindful control over use/abuse, and that the only cure is to seek "professional help" as part of the medical industry. This is not always effective. There are many examples: https://www.nbcnews.com/feature/megyn-kelly/florida-s-billion-dollar-dru... Of course, jail is not exactly "therapeutic," but for some, it's an ultimate cruel complication, especially if addiction leads to crime...
3
As an addict and alcoholic with 32 years of continuous sobriety, I know from firsthand experience and all of the scientific studies that addiction unquestionably is a disease. I have alway been one of the most disciplined people I know with immense willpower and that did absolutely nothing to help me recover. I also never wanted to be a moral failure of any kind and always tried to abide by laws and be a good person, even in the throes of addiction, so the negative behaviors that addiction created in me were no choice of mine.
It's also just completely counterintuitive to believe that anyone would purposely choose to wake up sick as a dog every day, penniless, homeless, absolutely lost and have the focus of their lives be to steal to get another fix or drink that does nothing but alleviate craving. Who would choose such an existence? No one.
But addiction is such a difficult malady to overcome that, from personal experience, it takes years, not 28 days or a couple of months to build a solid foundation for recovery and it takes the loving care and support of many. American society is one which chooses to discard addicts and alcoholics and then just look the other way. I can never see a day in this callous country where the well-being of the individual is more important than corporate profits, most definitely not under the Trump administration. With all of the political posturing, the situation is getting worse nationally, not better.
10
Sadly, attitudes toward addiction are steeped in a type of morality that has largely gone out of fashion in other walks of life.
Addiction is considered a moral failing and the "immoral" individual has to be punished. The punishment is dished out along moral guidelines.
Until this attitude is eradicated from our justice system, until addiction is seen as an illness that sometimes needs to be accepted and placed into a "maintenance state", i.e. accept the addict is either self medicating or otherwise unable to live without the drugs, there will be no progress but just misery, punishment and deaths.
Providing addicts with drugs, be it methadone, Suboxone, or actual heroin, is in many cases a better solution, with much better outcomes, than imposing sobriety.
Unfortunately, the medical profession is also pushing sobriety, even forcing it on chronic pain patients.
We are in the middle of a pendulum swing. The same people that over prescribed opiates for minor pain now refuse opiates to patients in life altering pain. By "life altering pain" I mean the kind of pain that keeps a strong, motivated person unable to move or even think, as the pain takes over their life.
Their current policy is to "change attitude toward pain". Meditation, in other words. A treatment that works for some, but not even close to even a sizable minority.
We will see more preventable deaths, more suffering, before we once again realize the foolishness of our policies.
4
Why should drug use, which harms no one but the user, lead to jail? Drug _distribution_ can harm others, but whom does drug use harm? Laws should not protect competent adults from themselves. And if drug users aren't considered competent adults, how can they be criminally culpable?
3
Drug users steal, rob, mug and burgle to get access to drugs. This is not a victimless crime.
1
It’s the robberies, mugging, etc. to acquire the drugs that are the problem.
1
Drug addiction should not be a criminal offense, period. But the fact is, the threat of incarceration is a powerful motivator to stop using. Drug cases need to be handled similarly to other behavioral problems, perhaps by social workers, but I believe that it is important to retain powerful carrots and sticks.
My observation from seeing a couple of friends go through addiction and recovery, is that most will need to bottom out before they will commit to a permanent recovery. If you have too much carrot and not enough stick, they never hit bottom and will just continue to bounce between spurts of being strung out and spurts of rehab.
2
People who end up in jail for drug use only are being incarcerated for a health problem. The fact that some drugs are illegal allows an illegal underground economy to grow. Participating in that illegal economy generates more illegal activity. Use and overuse of mind altering drugs affects self-care, limits cognition, and detracts from the sort of problem-solving that could lead one naturally to optimal health and mind-body care. The younger the user, the deeper the addictive patterns become wired through the user's natural self-reinforcing neurotransmission. It's a health problem. Period. Stealing to gamble at a casino or to buy street drugs - that is something beyond a health problem.
1
All you have to do is read the Times article "They Let Their 15-Year-Old Son Smoke Pot to Stop His Seizures. Georgia Took Him Away." to see how harmful criminalization can be.
https://www.nytimes.com/2018/05/30/us/marijuana-seizures-child-services....
4
Drug policy was never based on science when it first arose in the early 20th century and it is not today. A health issue, whether its obesity, substance use disorder, or bipolar disorder will never be solved if it is treated as law enforcement. In the future we will look back at the way we treat people with addiction just like how people with mental illnesses in the past were abused and beaten and thrown into cages because they “possessed by demons.” You can solve health issues with police. Obesity is also a problem but does anyone think it would work better if the government constantly monitored what we eat, kept records of waistlines, and then arrested us because obesity imposes costs into society? No, it would be ridiculous. Same thing with drugs. Spend money on health rather than police or just get law enforcement out of it altogether.
3
Drug abuse was not a crime in the 19th century. Sherlock Holmes abused cocaine and it was not a crime, just an escape from boredom. The number of addicted people resulted in efforts to stop it by punishment and making the unregulated trade a crime. This criminalization was intended to end drug addiction by extreme measures but it only produced a new way to make great amounts of money on a black market. The high prices caused addicts to commit crimes to pay for it. It's been a century, now, and this attempt to end drug addiction through punishment has created more social problems than the drug abuse problem did.
5
Maybe if we still had state hospitals where people could dry out and get clean. Alcohol and drug rehab might work better than jail, but it would have to be covered by insurance. Maybe instead of just closing the state hospitals, we should have reformed them.
2
If someone is addicted to anything, and they try to break the addiction....(take cigarettes for instance, or Alcohol)..they may try to get free many times, relapsing, then trying again. It just goes with the territory of addiction. The prohibitionist knows this and is eager to have the prison cell occupied again with their victim, thus "Relapsing" is criminalized .
Some are myopic enough to blame crime on addiction rather than the artificially high prices caused by prohibitionist laws which drive addicts to crime.
What would you pay to acquire a shot of Novocain when the dentist drill hits the nerve?
1
If an addict receives medicine which prevents them from getting high from the illicit drugs, does this make them a criminal or a patient? I would argue that makes them a patient.
If that medicine is taken away, and the addict relapses, and takes the illicit drug again, does the patient transform into a criminal? I would argue this person is still a patient.
4
addiction is a symptom of an underlying mental disorder or it would not take any longer then a detox to cure..if they cant be forthright enough to admit that our poorly performing treatment system needs a long over due overhaul
2
People who engage in criminal acts, after choosing to use drugs (which every person on the planet knows is harmful to yourself) and now the newest class of victims, according to this author?
And after years and years of programs for treatment of substance abuse disorders, there hasn't been a reduction in the incidence of them (https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-..., yet we are to believe that "treatment" is better than incarceration.
3
Seems logical that addiction, which means continually bathing the brain in harmful chemicals, alters the brain, thereby creating a chemically induced dependency. But addiction is more than willingly bathing the brain in harmful chemicals. It involves initial choices, and then a series of endless bad choices. However difficult it is to quit, it is a choice one can make. Treating it like a disease opens that door of manipulation addicts crave as much as their substance. It's manipulation of everyone within their grasp that enables and fuels their endless bad choices. As long as they can rely on that mindset, then they are 'not responsible'--someone else will always be to blame. Take it from me, two family members lost to addiction, they do not have a disease. A disease is random and capricious and cannot be banished with sheer will. Addiction can.
5
I believe any addiction specialist would tell you that a relapse is to be expected, and thus should not be seen as a total failure of treatment, but as part of the long road of recovery.
3
The story link to the Boston Globe regarding the death of Deb Silvestri was one of the most disturbing things I have read in a while, and there is no shortage of disturbing news these days. The comments of the judge after her death were despicable.
2
For now, there is no consensus as to whether addiction is a disease or a lapse in a person's instincts for survival.
If it is a disease, then relapse isn't a crime.
If it isn't a disease, then relapse may or may not be a crime.
3
We are one of the few places on earth where addiction is considered disease. This idea was started as a way to get insurance companies to pay for rehab.
8
Well because it's a disease that is also a crime (I know you want me to exclude criminality if its a disease) or it's not a disease, but a choice that is criminal. Although there is some overlap between medicine and law, they don't completely overlap. That will not be the case until our laws are dictated by the medical profession (is that what you are proposing?). Until then people have to live within the law or risk the consequences.
6
I'm a little surprised that--at least, in the NYT Picks--there's no mention of the relationship between addiction and pain, physical or emotional. Nor is there mention of the [sadly-not-]criminal involvement of pharmaceutical companies and alcohol manufacturers in our addiction epidemic.
Several jurisdictions are now suing pharmaceutical manufacturers to hold them accountable for these deaths. [See, eg, https://www.nejm.org/doi/full/10.1056/NEJMp1710756] It's especially hopeful that former Mississippi AG Mike Moore, who successfully prosecuted tobacco companies for hiding the evidence of their products' harmful effects, is leading one of these suits.
In addition to looking at the failures of our criminal system, we might do well to have a public conversation about the responsibility of manufacturers motivated by their quarterly bottom line and heedless of public health and safety.
But you're only an addict if you try the addictive substance in the first place. If you never try it, you can't get addicted. There is a lot of forethought that goes toward the decision to do business with a drug dealer and ingest a dangerous substance, rather than making the decision to seek a mental health professional (and don't tell me that's expensive - drugs are even more expensive and there are free clinics) or even just speak to a friend. Also there are horrendous global consequences to taking drugs, going all the way back to where the drug was harvested in the first place. So I'd argue for treating the first decision to seek drugs as a crime, before addiction has even occurred.
9
I do not care what a person does to her own body or property. I care a great deal about what she does to yours and mine.
8
Our self-righteous, punitive Puritan heritage at its worst.
4
Interesting that the DSM is the "final authority" on determining what is and is not a mental disease. As late as the 1970's the DSM classified homosexuality as a disease. Would the authors argue that homosexuality really was a disease back then?
9
Addiction is more widespread than is commonly acknowledged. Addiction is the use of substances and or activities to numb the pain and sorrows of everyday life. Or even to block out feelings and bodily sensations more generally. We don’t like to feel things because feelings compromise the sense of control. We treasure the capacity to be “objective”, to be rational in perceiving and responding to the truths of our lives and the lives of others. So we block out feelings by over eating, drinking excessive amounts of coffee or other caffeinated drninks, being obsessed with sex and “love”, accumulating obscene amounts of money where enough is never enough, by working nonstop to stem the uproar in our souls, by getting drunk and or high to never have to face our lives. Who is not addicted to something?
7
Talk about disease all you want. No one, not even the writers of this editorial, want to live next door to drug uses. No one. If not jail time, then at least removal from the community. Members of the community have rights as well. These include the right not to have our community disrupted by those who engage in drug use rather than behave like morally upright members of our nation.
15
Are you kidding? They don't even want the treatment centers in their communities. Of course they will take a 6 figure job running one of those treatment mills in another community. One they can pack up and leave at 5pm while leaving the residents to deal with the issue of drug addicts hanging around all night.
2
Cancer patients and diabetics generally do not steal from and assault their neighbors or neglect their children. Many addicts do. I think it is more complicated than just calling it a disease. In addition, jail may be the best option for keeping some addicts alive and forcing them to get clean.
10
The real "crime" here is the Sackler family who runs Purdue Pharma and continued to manufacturer OxyCondin long after they knew the potential for addiction - meaning the physical body craving for "more." Unsuspecting patients, prescribed such drugs were unwittingly trapped in this addictive craving through prescriptions from doctors who were marketed the drugs as "safe" which then, in turn, created patients who could not stop.
Prison is not the place for individuals addicted to prescription drugs. Rehabs financed by people such as the Sackler family need to be held financially accountable for the horrific, addictive harm and destruction they have caused.
The Sackler family with all of their "philanthropy" has been able to do so on the backs of innocent people addicted to the substances Perdue Pharma knowingly manufacturers which is. of itself, criminal.
2
The answer is simple. Sentence them to rehab treatment - for the entire duration of their jail or prison sentence. Problem solved.
3
If someone commits a crime they don’t get a freebie because they have cancer. The comparison between addiction and other mental disorders is more appropriate.
8
A college student, for relapsing from his bipolar disorder, was terminated by his college, and arrested and jailed for over 100 days; and since release jail, the prosecutor (probably at the urge of his former college) is trying hard to convict him on criminal charges for writing delusional blog posts, and will probably get convicted. For a couple of years, he is already having hard time finding employment, even a minimum wage job, as he holds no college degree and has diagnosed mental illness. His former college and the court are trying very hard to add one more disqualification to his existing 'credentials': a criminal conviction for writing delusional messages. This is one sad situation.
2
Here is what we know - rehab has a dismal 'cure' rate - somewhere around 5-10%.
Here is what we know - part deux - prison - cold turkey has a 100% success rate.
Now - the moral question is whether we should be subjecting 'free' individuals to enforced withdrawal for their own good.
6
SteveRR, where do you get this idea that addicts can stay 100% sober in prison? All kinds of things happen in prison. They ferment prune juice in plastic bags under their cots to make alcohol. They smuggle in heroin in their behinds or through corrupt guards. And there is always a corrupt guard, or one who can be persuaded or induced to help in the smuggling.
Anywhere you put an addict with an active, untreated addiction, that addict will find a way to bring the substance of dependency with him or her.
My husband once found pint of vodka buried in the rose bushes, stashed there years ago by an alcoholic family member who was forbidden from bringing alcohol into our home.
Treatment is the only way out. Just keep treating each relapse. Eventually it will take.
1
Prison does NOT have a 100% cure rate. Drugs are a serious problem IN prison.
2
OK - so thanks for your well thought-out replies - but let's look at the basics - is an addict more likely to have ready access to drugs in prison or in their own neighborhood?
Actually *all* aspects of the disease theory of "addiction" have been debunked for decades, except for the "brain disease" nonsense, which has been disproven over the past decade.
"Addiction" - more accurately phrased has habitually problematic substance use - is no more a "brain disease" then practicing the violin, meditating, or playing tennis.
The next couple of decades will find the notion of "rehab" for habitually problematic substance use will have a massive wave of class action lawsuits.
See also thecleanslate.org
5
Some commentors feel that this is not a simple problem to solve. They don't want to incarcerate people, yet, a tremendous number of burglaries, robberies, thefts, and other crimes are done to feed a drug habit. Often violence is involved. To let the perpetrators walk free is to guarantee that the people who are having their lives threatened and their property stolen will continue to suffer.
We live in a country where most bad behaviors have an excuse laid out. If you drink to much you are addicted to alcohol and need treatment. Take opioid's and other drugs it change your brain structure and you are not responsible for what you do. Many other crimes are committed because of psychiatric illnesses that make it impossible for the person to control themselves. There is an excuse for just about anything. Few people take responsibility for the wrongs they do in America. Why just a few hours ago one of our TV stars Twitted that they had made racist comments because of the affects of Ambien, taken to help her sleep. When no one will take responsibility for their actions - we are a very morally and ethically sick society.
Last week I read that doctors had estimated that 1/3 of our population was always in intractable pain! Am I to believe that 1/3 of our people have sustained injuries that DO NOT heal? Horse droppings!
Time for us to accept the pain in life, stop complaining, and get on with living.
7
Joel Friedlander--you obviously have never been in severe, intractable, chronic pain--the kind that won't go away no matter what. The kind that does not allow people to live full lives. The "horse droppings" are people who think it's so easy to "accept" pain. Sorry, but your view is disgusting and disrespectful to those of us who will never live without pain.
Walk a mile in our shoes and then judge. Hope you never have to find out what severe pain does to a person and how it makes life unbearable. You're lucky--for now, but don't count on your health luck holding out.
1
The writer should make clear that it is type 2 diabetes that is related to personal choices such as diet. Type 1 is a genetic condition.
5
"type2 diabetes is related to personal choices such as diet." Uh, uh. No. Not always the case--ever seen a skinny, health-conscious type2 diabetic? I have known a number of them, including my father who died of renal failure. It's genetic pure and simple. The old tired meme that people with type 2 are gluttons and "immoral"l ought to go by the wayside.
Welcome to the 21st century. Enough with that myth.
2
If addicts who relapse are tossed into prison perhaps we should start locking up alcoholics who fall off the wagon.
2
If they commit crimes while drunk/drinking, why not?
8
I have more questions: Why were and are people who may at one time in the past, arrested and convicted for the "crime" of possession of drug paraphernalia-a hypodermic needle, or, in many cases, merely a glass eye dropper with a rubber infant's pacifier attacked-not even any illegal items but, if a person is or once was, artrested for their possession, they could be sent to a pentitentiary for not actually criminal anything-also, these same folks could and with regularity, arrested and convicted for the " "possession of Burglars tools" if they were searched and police found keys or someone else's keys, or a screwdriver or small clasp knife , one of which I owned made by Tiffany , but if made of steel and plastic, it is a burglar's tool.
mashed together like the old hobo's Mulligan Stew,(whatever grub was around the campfire , went in the pot),, to make a legal mishmash probably with little basis in laws but useful for blackmailing "dope sick" drug users-especially addicts in withdrawal-to get them to plead guilty to other, sometimes lesser-often greater, crimes. The lack of knowledge among addicts left them open to be turnedand made "rats" , the tools of the police and ambitious ADA's and DAs who would ride their backs to high office. One time, in the 1980-90's
this criminal system of criminal prosecution almost fell when an eppeals court decided it illegal and unconstitutional. Supremes decided it far more important to maintain "cops and robbers" then the constitution.
2
DSM = "final authority on psychiatric conditions". This misapprehension must go. The human condition is far more complex than that.
4
Reading through these comments, all I can say is that this "personal responsibility" cult is vending the most potently addictive drugs by far: the drug of feeling superior to others without having to make any effort whatsoever!
6
I have an alcoholic family member. I am very glad she does not get treated like a drug user. She was sent to 90 days rehab by the courts when she was caught drinking in a parked car, with her keys tossed in the back seat so she couldn't drive. She is six months sober now. I'm glad she was sent to a place of healing and recovery rather than jail. She grew up with PTSD and jail just would have retraumatized her and made her more determined to self-medicate. And put her into contact with people who have drugs. Jail is not a sober environment. There are alcohol and drugs in jail.
I think we have to stop treating alcohol like it's different from other drugs. Alcoholics and drug addicts are often the same people. We can't tear the person in two and send the alcoholic part to rehab and the drug addict part to prison. We should treat addiction like it's one whole person who has that problem and both parts of that person should be treated the same.
State legislatures controlled by Rs will not allow Medicaid to help pay for drug rehab. They hold it is a moral failure of the addict. With Purdue Pharma filling the streets with opioids for profit one can see the faulty logic of the reincarcerating drug offenders for failing drug tests. Drug addiction like alcoholism is a disease not a moral failure. Treatment can not guarantee positive outcomes but leaving people on the street seeking drugs is a much worse solution.
1
The drug war is worse than the drug use. If heroin were legal few would be dying from prescription opioid overdoses.
The drug war just rewards violent criminals with higher profits than if drugs were legal, regulated and taxed.
We need to forget sending people to prison and start using drug war money for treatment, prevention, and improving people's lives in general.
4
One of the rare but most effective ways to immediately stop a drug addict's cravings is to place them in a tub of cold water for just a minute or two whether they want to or not. Don't know why this isn't used more often. Nobody knows why it works but it surely does. Simple and effective. Do it each time they crave and within two weeks (or less) they crave no more. Cold is very, very effective against drug addiction.
2
David, and yet look at how much alcoholism there is in the coldest parts of Russia. People get drunk in any weather. Go figure.
2
If you committed a crime to support your habit, then you do need to be held responsible for that crime. If the punishment requires jail time perhaps there can be a section of a prison, or an entire facility, that will provide treatment for those who want it. Just about everyone who goes to prison will at some point be coming out and will have to rejoin society. We might as well try and help them be successful at it.
3
This sounds very nice in the micro. Now apply it to the macro, where illegal drugs are trafficked as a business. An illegal business, so you can't settle your business disputes with lawyers, because no court of law will hear your suits.
What happens when the drug squad comes in and holds these business people accountable by arresting them?
Job openings at the top of the industry! Jobs the lower level executives are literally willing to kill for. And now rival companies see new sales turf opening up too. Another thing they will kill for in an industry put by society beyond the rule of law.
And who betrayed the drug executive to the police? In addition to the job competition that leads to homicide, there is also a hunt for the snitches that will lead to homicide.
I'd really rather we found a better way to deal with the problem of drug addiction than the way we are doing it now. Drug and alcohol addiction are really the same problem. They should be treated the same by the legal system.
I would say that criminalizing addiction is tyranny. It serves no purpose other than funding added court systems, police forces, and jails. It is an illness. I have a relative in which a doctor prescribed vicodon for a not treatable back pain. After a year of prescriptions he dropped my relative. The real criminals here are the pharma companies and the prescribers.
4
Neuroscience now recognizes that the conscious "will" has less power over the brain than "personal responsibility" advocates imagine. Most of the human brain functions with utter disregard for what the conscious portion of brain tissue commands or desires.
Also, opioid withdrawal is a very serious affair, there can be convulsions that can be life-threatening, and the whole experience is terrible in general.
People on opioids should not be encouraged to go cold turkey. Opioid withdrawal should be done under medical supervision. The conscious portion of one's brain tissue has no power over the medical effects of opioid withdrawal.
1
Being one of the lucky ones who escaped chemical bondage through a conscious choice and the help of AA groups, I have to say that success in recovery depends on the ability to see yourself as worth saving. Jail doesn't reinforce that point of view so far as I can tell without having been there.
8
“It’s not that they don’t have free will,” says Mark Kleiman, a professor of public policy at New York University. “It’s that they are exerting that will against such a colossal force.”
Pure doubletalk. Addicts do not have free will when in the throes of their addiction. This is the very essence of the disease model of addiction. Addicts have no more control over their jonesing than cancer patients have over their errant cells' metastasis. I might add, we don't get mad at cancer patients; neither do we put them in jail.
1
Why does this piece omit any reference to the underlying crime that landed Ms. Eldred in the criminal justice system to begin with? Is it because we are to believe that her only crime was becoming addicted to drugs?
A quick search of the Mass. Supreme Judicial Court web site reveals otherwise.
7
Conservatives believe there isn't an addiction that will power can't conquer. Leftists believe there isn't an addiction that the addict can completely conquer. The truth is very much in the middle, and the reasons multifactorial.
2
No, most liberals simply want evidence-based policies.
When scientific studies show that addiction treatments work and that without any addiction criminals tend to be no longer a threat for innocent citizens once they get out of prison, it's in your and my own security interests to treat imprisoned addicts, period.
1
Socially it is vital for civilization that people accept and honor the concept of personal responsibility. But science is showing us that the brain is complicated and the power of conscious will has been greatly exaggerated by Western culture, especially when it comes to addiction.
Most brain functions are performed with no conscious control whatsoever. Indeed, the brain was shaped by evolution so that we don't have to be conscious and exert the force of will in order to stay alive. We don't die when our conscious brain goes to sleep every night, right? The necessary systems keep working.
And while we are conscious, we are driven by urges of hunger, thirst, breathing and elimination that our conscious minds also have little power over.
Some life events, especially in childhood, can further weaken the power of the conscious portion of the brain over the rest of the forces roiling around inside.
This is just science. Policies on addiction should be based on science, and science is showing the way out. Treat the person like they have a brain worth saving. And help them understand how to strengthen the conscious, responsible portion of the brain. Help them push back against the effects on their conscious will of adverse childhood events.
And give them mental health treatment if they are dual-diagnosis, coping with another issue like bipolar or depression in addition to the addiction.
1
This article is right on. The criminalization of relapse is but one tragic feature of our misguided system. Ironically, we have just discovered that the legalization of marijuana did not end life on Earth. Nor will the legalization of relapse.
Laws are slow to change but when they do, the misguided series of unintended tragedies quickly abates. Though no fan of drug addiction and the concomitant constellation of suffering it spawns, I support keeping addicts out of the criminal justice system. Provide them legal access to the drugs they crave and treatment they seek. We’d save money, lives, time, families, and free up resources to pursue worthy crimes.
1
I am a board-certified psychiatrist.
Addiction is not a disease.
If you are interested in this subject, I suggest you look into it.
Sorry, not going to do your work for you.
Pay attention to all the $$ involved--from psychiatry and the mental health field to the addiction treatment centers and therapists.
Follow the money, including that spent on the unconstitutional War on Drug Users.
Think for yourself?
8
Your comment perfectly illustrates why so many people tend to discard psychiatrists in the first place.
1. "Thinking for yourself" means forming your own opinion, based on the available, proven evidence. It does not mean refusing, as a professional in this field, to give other people the relevant information that your job requires you to constantly look for.
2. Psychiatry is not a science. That's how one psychiatrist (you, for instance) may adhere to the opinion that addiction isn't a disease all while having the American Medical Association officially declare that it is.
3. Efficient addiction treatment centers do MUCH more than just providing "things that can be bought". They teach people trying to get rid of their addiction how to increase the brain networks in their frontal lobes that are responsible for self-regulation and emotional comfort, and THAT is what allows them to have no more relapses. It's absurd to imagine that somehow an individual could teach this to himself. So yes, we as a society HAVE to step up here and take our own responsibility.
4. If you want to contribute to having more citizens "thinking for themselves", maybe you could start by giving us some concrete arguments about WHAT we should do as a society, according to you, with imprisoned addicts, once you oppose any form of treatment?
5
USE a crime, therefore relapse is a crime, That is the predictable outcome, nay direct consequence, of an idiotic drug law.
1
We're a racist country. End of story. For white people, drug use is fully legal and drug abuse is treated not with prison but concern.
3
There are so many factors at work here, but one glaring mistake is that we judge addiction as a moral failing. Is it immoral to overeat and gain weight, be addicted to cigarettes, drink in excess, gamble to a fault, or be attached to a partner who is abusive?
As far as selling drugs-- is it immoral to sell cigarettes, alcohol, unhealthy food? Is is immoral to deal cards to a gambling addict?
A "normal" person may not become addicted to alcohol, marijuana, gambling, food, or relationships-- but they would become addicted to nicotine and opioids.
An addictive personality on heroin is not someone who belongs in jail or on the streets. That person deserves help, patience and love.
2
So much to rethink in criminal justice policy around drug use. Common sense would help.
I'd start with hosing down the false emergency rustled up each election cycle to contribute to a political public relations campaign called The War on Drugs.
Drug users are sentenced similarly to violent criminals.
This is injustice.
Why do we hyperventilate, when they are a threat to no one but themselves? Because we're gullible and persuaded by politicians that the solution to our problems is to be tough on them.
The prevalent view is that a drug user is ruining their life, so we should fix this by putting them in prison for 20 years. That's not common sense.
Ditto low level dealers, who support their personal habits by siphoning off a percentage to supply their fellow neighborhood addicts: and common sense tells us that there is huge distinction between someone like that, and a serious operator. Yet they get life.
It's also utterly cruel to let someone go through cold turkey withdrawal from heroin in a jail. A process which is at best a nightmare in the most gentle of conditions, is torturous under incarceration, and making someone go through that hell, when a very inexpensive pill would stop the suffering is inhumane.
2
Addiction runs through my family. Lies are their currency. They steal, they get into trouble, they drain bank accounts, they abuse everything in sight — relationships, belongings, everything. I look at the millions of dollars being sucked into treatments, the real and sham rehab places that are thriving, bleeding insurance and therefore bleeding the rest of us, and if I’m honest I say addicts are just not worth it.
4
There are over 25 million people in recovery from addiction and many of them are clean and sober directly because of the criminal consequences associated with their actions while under the influence. There are public safety considerations with this “disease” that are not present with hypertension, Alzheimer’s or a host of other diseases. That’s a big difference that this article fails to address.
14
Many people are dealing drugs in prisons too, thanks to those same criminal consequences. And many prison guards have been corrupted. Prison does not make anyone value sobriety or teach them what to do with their trauma and cravings after they are released. In prison there is no place you can go to get away from addicts and their smuggled-in drugs. It's about the worst possible place for an addict to try to get sober.
This myth that addicts get clean in prison is doing a lot of harm and creating a whole new kind of drug smuggling and prison-based crime.
1
The very idea that two years of law school somehow qualifies one to be an expert on the best way to handle drug addition is a complete absurdity. A law degree only qualifies one to take a test to get a bar license - that's it. And it's not like a legal education is particularly taxing intellectually.
Yet our society has consigned decision making over a complex public health issue largely to lawyers. Whether they be judges, prosecutors or defense attorneys, we allow people with no training or expertise to diagnose and treat addiction and then wonder why the problem only gets worse! Asking a judge to determine "what's best" for a drug addict is like asking your office's desktop computer support technician how to treat pancreatic cancer.
Seriously, what fool would go to a lawyer to lance a boil? Lawyers are experts at filing papers and giving advice theoretically based on law. But they are not trained to be doctors, sociologists, psychologists, social workers, managers, public administrators or anything else that would qualify one to make decisions that impact public health or policy.
2
Your anger is misguided. Lawyers and judges are rarely the ones "diagnosing" addicts. They are instead trying to convince, cajole, and eventually force the addicts to go get the help they need.
The problem is addicts don't often listen.
And sadly, when they don't listen, they often wind up right back in front of the the judges and lawyers for a plethora of reason, drug related and otherwise.
4
Your defensiveness is misguided. "The problem is addicts don't often listen" is precisely the kind of facile 'diagnosis' judges and attorneys are fond of making - which is the real reason addicts cycle back before the courts.
I've worked for the criminal courts longer than I care to think about. The justice system is a bureaucratic meat grinder. Judges and attorneys are simply moving cases - or if it's the Bronx, everyone just sits around vainly waiting for the attorneys to show up. Nevertheless, the very idea that cycling 30 defendants through a daily jail chain gives anyone the opportunity to "convince" or "cajole" a hapless addict into "getting help" is patently absurd.
It is a mistake to try and fit drug addiction into some existing model of disease, crime or psychology. Seeing it as a unique problem will free us to find better solutions. Some are prone to it, some are not, some can quit, some can't, and addiction always leads to crime (except maybe when it's government approved, like alcohol and tobacco). And nowhere do I see an acknowledgement that people do drugs for the same reasons they drink, smoke, and eat junk food. Sometimes the prescription meds set someone off, sometimes it's the recreational pursuit of pleasure that goes wrong. Underachieving also-rans in the rat race of life who chose drugs as an escape are pretty rare except in the literature and the cautionary tales to young students, but completely absent are those persons who try drugs because they've heard they are pleasurable, and find out that in fact they are. We start out by telling lies, avoiding the truth, and trying to frighten people. Maybe taking a good look at education would be the best place to start. Kids who think they've been lied to often decide to prove the truth is the opposite of what they've been told.
2
Should we lock up people with a cancer relapse? The logic of this headline is astonishing.
1
This deserves at least a trial then adjust over time if deemed necessary.
https://find.cato.org/search?as_sitesearch=https://www.cato.org/publicat...
I do not care if people use drugs or kill themselves. That is their business.
What I do care about is drug addicts committing crimes. If they do so they need to be prosecuted and sent to jail.
I think addicts should have access to treatment- once. I am tired of the endless rehabs which our entire society has to pay for.
Perhaps it would be better to just give the addicts drugs and let them do what they want. Society cannot make a person stop using drugs if they have no interest in stopping.
7
Please refrain from using the stigmatizing language of "addict" in reference to substance use disorders here and throughout your newspaper. As you should know, language matters, and the more you continue to use stigmatizing language the more damage you do to reducing stigma. It is stigma that prevents people from getting help. As you point out, substance use disorder is a chronic, relapsing medical condition, please use the preferred and accurate language to talk about it. We should expect more from the New York Times.
2
There is no discussion of whether drug treatment was ordered as a part of probation and/or whether it was followed through with. I imagine the judge told Ms. Eldred to clean up so she stops stealing other peoples things.
There is no discussion of whether this was the first time the defendant tested positive during this probation. Given the nature of addiction...
There is no discussion of whether this was the defendant's first, or second, or millionth larceny conviction. The rules can and do change if you've been offered drug treatment classes 1,000 times before and you reject them every time.
I am fully supportive of treatment over prison for drug-use situations. But this isn't a pure drug use situation: it's probation for a conviction of the theft of someone else's property. If we are going to have a meaningful discussion on drug treatment during probation, give us all the facts. There are glaring holes in this story that instantly call into question just how lenient we should really be toward Ms. Eldred.
2
Addiction is the crime of lazy, relapsing is lazy, conservatives generally won't see it any other way. They might reconsider if a family member is involved, but only if that person was not lazy pre-addiction, otherwise they won't. Lazy means you had time to think or act out. We need to have a discussion on lazy and slavery as there seems to be no middle ground in the conservative agenda which is why they are so intent on destroying the middle class and forcing us into poverty and then having us, the new poor work ourselves to death. Of course, they aren't lazy, they are christians, pulled themselves up by their bootstraps, walked five miles to school in the snow, never took a handout (tax breaks are not handouts), etc. you know the type, the self serving lies that you have heard all your lazy life...serving up still more lies daily to justify our conman president.
Addiction is a compulsive obsessive phenomenon, it is not a body trying to fight off a pathogen or dysfunctional cells causing a disease. This attempt to frame problems in terms of things that we know how to address, like war or polio is a mistake. People who are addicted respond to cravings instinctively and have lost the ability to restrain themselves. They can learn to control themselves but it is not easy.
7
Some of the comments here are deplorable. Many Times readers usually show sympathy for people who end up in bad life circumstances, and bemoan a system that prevents people from being able to improve their lives, and that leads them to commit crimes, etc. It's never the person's own fault. No talk of personal responsibility there.
But when it comes to addicts or people who are overweight, your empathy and perspective abruptly vanish. Suddenly, it's "Well, they made bad choices so I don't feel sorry for them."
You do not have a clue. It doesn't matter if you want to call addiction a disease or not. What is indisputable is that it induces changes to the brain, and as those pathways develop, they are there—and yes, they begin to control behavior. You have no clue why someone uses a drug for the first time: peer pressure, depression, anxiety, just a moment of really bad judgment... the reasons are many.
You never got addicted? Never tried hard drugs? Tried them and didn't get hooked? Good for you! You're superior! Your moral fortitude is a model to us all. But maybe you could use some humility. No one wants to grow up to be an addict who is in and out of withdrawals, and in and out of jail.
Those of us who aren't wired for addiction, or had the lucky combination of genes and environment that led us to not think drug-use was normal and do not have a mental illness that was finally relieved by an illicit drug when nothing else worked.... There but for the grace of God go I.
18
Most people do not in fact become drug addicts, even if they face considerable adversity. Addiction is the exception to the rule, not the rule. We should offer treatment and try to prevent the problem in the first place, but don't treat people without that problem as if they ARE the problem.
4
when did the contents of your blood become the business of the state? I suppose with alcohol and driving laws. It used to be that it was possession of a substance that was the crime.
1
Certain wrongs deserve punishment. Being sick is not one of them. Pretty obvious.
On the other hand, laws and crimes are made by the lawmakers, or perhaps we might call them crime-makers.
The law reflects the distribution of interests and power in society, not what is correct. Philosophers knew this since the death of Socrates -- we might say Socrates had first-hand knowledge of the difference.
Before recorded history, ever since the first Hitler, grabbing a big stick, claiming a right to rule us, and the fools failed to promptly put him to sleep, the rulers have given orders, decrees, laws and punishments contrary to ethics.
Why should addiction law be different?
4
ALL of our drug laws are made and designed to suppress voter turn out. We now know this and we also know that the DEA our own terrorist organization was set up for the sole purpose of villainizing young voters knowing our rotten media would go along. As a nation we are guilty of crimes against humanity ALL because of our vile illegal drug laws.
Why does alcohol get a break. Alcohol is BY FAR the biggest killer and one of the hardest "drugs" to get off. But our vile media will never do the right thing.
1
A few years before the turn of this last century, about 50% of our drug and alcohol rehabs had been shut down. That was around the same time that the private prison industrial complex came into being. Coincidence? My cynicism tells me it wasn't. We talk proudly of our Puritan heritage, neglecting the fact that the Puritans punished everyone for the slightest infraction and had no interest in religious freedom for anyone but themselves. We would be better off as a country if the Mayflower had broken up on the rocks.
Relapsing from the disease of Addiction is a crime because the private, for-profit prison lobby and their compliant water-carriers in Congress say so.
2
The agony of addiction is a terrible punishment all on its own. The user becomes an addict as they trade money free will and in some cases morality for what is at first a great high that turns into simply a maintenance dose to keep the physical withdrawal symptoms at bay for 4 more hours. The thought that someone living that lifestyle is happy when they are supporting the habit with theft, prostitution, or drug dealing is ridiculous. The main steam good element of society needs to understand what these poor souls are going thru. Many cases it all started with a prescription from their trusted family doctor.
2
The big problem is we have separated body and mind diseases as if they are not two sides of the same coin.
We believe, wrongly, that morality and choice affect our mental issues.
3
Statistics vary but many alcoholics\ addicts also have co occurring disorders, that is, other mental health issues along with their addictions. Some cite percentages as high as 60% of addicts, some lower. I have been in 12 Step programs for 24 years and I have certainly seen a shift toward more frequent psychiatric treatment along with getting sober. But, to argue disingenuously, that addiction is not a disease when it is convenient to make a case or argument for the state is trying to turn
2
Addiction is definitely a disease. I've worked with addicts for the past 10 years, and currently work in a government program that addresses co-occurring disorders, with the imminent threat of jail. Clients in our program come from jail, and have that looming over their heads the entire time. We have very low long term success rates. Also, MAT is incredibly helpful in helping clients with alcohol/opiate issues gain some clean time and confidence that they can stay clean.
3
All of these addicted people are somebody's child, sister, brother, mom, dad. Are we not thankful for the parables of the lost coin and the lost sheep in the Gospels? We are glad that Jesus promises to never give up on us when we fall short or stray. We need to approach each other with that same unconditional love.
10
Along the right field wall at Hagerstown’s (MD) Municipal Stadium is a sponsor’s billboard that reads “Less Judgement. More Compassion.” It’s for a non-profit addiction treatment center. If it were me, I’d make it “Less Judgement. More Science.” Viewing addiction as a moral shortcoming (therefore subject to criminalization), rather than a disease (therefore subject to medical treatment), is holding back efforts to turn around the ravages of the current opioid epidemic. Not sure I agree 100% with the article; incentives are important factors in modifying addict behavior. And many in the recovery world have doubts about medication assisted therapy as the wholesale answer to the problem. But let’s argue on the basis of science, not prejudice.
7
People aren't sent to jail or prison for having a disease or a recurrence of it. They are sent to jail or prison for criminal acts related to a drug they're not legally allowed to be anywhere near. One could call that a disease, or could call it a predictable set of outcomes from initial bad decisions, or could call it a crime, or some combination of these. It is up to society to figure out how to prevent those acts we currently consider as criminal. Nobody, however, is going to jail for non-criminal acts relating to any disease.
9
The concept that mind and brain are somehow separate entities leads to profound misunderstandings about how brain chemistry and therefore behavior can be altered by the addition of certain substances. This leads to belief that addiction is somehow "weakness" or "a character flaw" that can be overcome just by applying good ol' American grit and willpower. There are chemicals that can destroy the kidneys and we don't quibble about morality, we just fix the problem. Why do we treat the brain any different? Because many people find the concept that mind IS brain and therefore physical and not supernatural uncomfortable, that this would destroy the illusion they harbor that somehow humans transcend their physical selves. Sorry, but fact is fact. Mind IS brain. Destroy the brain and the mind is gone. Damage the brain and there are tangible life-long consequences. Then again, in this country when there is a choice between carrot and stick, we go all-stick, all the time.
1
Like with any addiction, the addict will get clean when the addict decides that there is a better way...
I'm all for treatment...And, I'm all for in-patient style treatment centers and programs for those that do not engage in violence. They may be the ONLY ways successfully to turn lives around.
But, we have laws, laws that WE, THE PEOPLE, have determined that should apply to users, dealers, mules, and the cartels that move the drugs into and through our communities. Somewhere, sometime, there either needs to be due respect to and for those laws or those laws need to be changed.
Those laws are not going to change any time soon, and we all know it. It's a waste of time and resources to other than to keep the thought alive.
But here's a suggestion...Instead of incarceration in a prison, why not permit judges to sentence those guilty of non-violent drug possession and use because of addiction to significant terms of in-patient drug detox and rehabilitation with increased sentences for relapse and or/parole violation.
It would mean that there would need to be funding and resources dedicated to treatment and treatment centers, and that funding will need sustained commitment from our political leaders and representatives.
To the argument that we would be just throwing more money at the problem, I would answer with this:
We're spending obscene amounts already with little to show as progress. Just move that money to programs that might have a chance to succeed.
4
"Addiction" does not exist. Physical changes that make you really, really want something does exist, but it remains a choice, and I have not seen a single person incapable of choosing differently, no matter the drug of choice.
Yes, therapy can help. Social support can help. But it is a choice.
We need to legalize and reasonably regulate recreational drugs to make them safe and to de-fund criminal gangs.
We need to let some people kill themselves with their choices, as we do with alcohol, tobacco and food. (Although I prefer coercive intervention to end obesity to the current hysteria over the "demon opioid.") If people put others at risk, then we need case-by-case prohibition as we do with drunk drivers who are drug-tested for alcohol for up to two years after a DUI, and who receive coercive sanction if they violate their case-by-case prohibition.
Certainly, the choice to use recreational drugs can be responsibly made, as a large study in the 1990's showed that even 90% of heroin users were successful, recreational, users (about the same percentage as with alcohol). And just as certainly, lack of opportunity and loss of the meaning of life makes the choice to "abuse" drugs more likely to be made -- but it is still a choice.
In any event, our current approach to drugs is stupid, incoherent, and assures the prevalence of massive criminal enterprises, deaths by tainted drugs and overdoses, and ridiculous levels of imprisonment of otherwise tax-paying citizens.
Ms. Eldred was convicted of larceny. She stole money from someone who didn’t get it back. No doubt she stole to fund her habit and, if she relapses, she will have to steal again. Her problem is her disease. And because of her disease, those around her are all larceny targets. Child sexual abuse is a disease. Sexual abuse of women is probably a disease. If you can’t imprison people for harmful diseases, their victims will be victimized over and over again.
1
Addiction is a life choice, not a disease. It's like a diabetic eating cheesecake and finishing it off with Mountain Dew. The diabetes can be controlled based on choices and they choose to roll the dices.
This whole disease nonsense is being pushed to keep white drug addicts out of jail.
3
While addiction is a disease, if an addict shoots me to get money to fuel the addiction, I prefer that prison be part of society's response.
1
Addiction, unlike a disease which strikes unwitting victims, is self-imposed. Don't want to get addicted to heroin or meth? Don't try heroin or meth.
5
So what about the child molester, sexual predator or person convicted of multiple DWI's when they relapse? Treat them as victims too?
1
The influence of Bill Wilson has seeped into the fabric of this nation. Let's not forget that the Big Book was essentially the product of a hijacked mind and Bill Wilson was a huckster in many ways, a sociopath and serial cheater who turned to LSD after he gave up alcohol His addiction never subsided with his program. He smoked himself to death. To tie this quasi-religious movement to the criminal justice system at the expense of evidence based treatment is a travesty of medicine.
2
NY Times Editorial Staff: your editorial achieved its purpose, it forced me to stop and think about our judicial system. Having viewed several trials of drug addicted citizens I can truthfully say that the penalties incurred by the addicts had no relation to the crime committed. The judge never discussed medical, psychological or social help and programs that may offer the addict the help and support necessary to overcome their addiction. It became evident that the penalties and fines placed on those addicts found guilty were simply used to help finance the court system and help private prisons and bail bond businesses show a profit, rather than committing the community to the costs associated with providing the addicted with long term treatment and care, From my perspective, the court system is perpetrating a real social ill by returning the addict to prison to spend additional time among a group of addicts with little or no medical and psychological help. Does this sound like a rational plan to help the addict overcome their dependence on drugs? The court system limits jail time to those wealthy individuals who can afford a good lawyer and preys on the poor souls who can't afford to hire an attorney. In many cases the addicts are forced to accept plea deals. If one studies the results of our so called war against drugs it becomes evident that the statistics on recidivism bear me out.
2
this statement in this article is as wrong as it gets -Only in death do drug users become victims. Until then, they are criminals.
1
personally I believe addiction a mental disorder particularly as it relates to substance use. bottom line is that drugs are for people who can't handle reality and reality is for people who can't handle drugs.
Jail is the perfect place to treat their "disease". The public does not need to suffer from their crimes and it gives them time to think, as there are no "scores" to hustle. Only a junkie can help themselves as it is a choice. If they need support, offer it. Otherwise keep them, and their bad choices, away from functioning society. Junkies are not harmless, they contaminate other people.
1
The disease model is bogus. And if I recall correctly, the DSM-5 doesn't even use the term "addiction." And it certainly doesn't use the term "disease." The disease model has been foisted upon a gullible, powerless American population by Alcoholics Anonymous. The disease model is an exercise in stupidity, maybe even totalitarianism.
4
Addiction originates from a society that is intrinsically sick. The individual is left to him or herself, and even when a person badly needs help, asinine privacy rules prevent the next of kin to be notified that a disaster is in the making.
So, yes, addiction is in fact an organic disease, but one with environmental origins that are secondary to our society that is rotting at its core.
Just look who we elected for president. That says it all. It is either a cry of desperation or a statement that voters have stopped caring.
Dog eat dog.
No wonder more and more people are turning to drugs to escape it all.
Addiction, possession, sale and use of illegal drugs is and always been a crime for black African Americans deserving of mass incarceration. Blacks were profiled as being part of an ignorant immature and immoral crime wave.
While white European American addiction, possession, sale and use has been viewed as empathetic sympathetic and tragic. Part of a disease epidemic.
Drugs should be treated as a potential health medical abuse problem akin to alcohol and tobacco. Legalize, educate, regulate and tax. Until then whites should be imprisoned as the best deterrent, effective life saver and punishment.
2
The disease model is bogus. And if I recall correctly, the DSM-5 doesn't even use the term "addiction." And it certainly doesn't use the term "disease." The disease model has been foisted upon a gullible, powerless American public by Alcoholics Anonymous. The disease model is an exercise in stupidity, maybe even totalitarianism.
Merely seeing the word "disease" in the title gave me enough shivers to despise the mere thought of reading the article, which I didn't--indeed, couldn't, for fear of my mental well-being. The disease model makes multitudes of folks feel that way, but, by and large, no one listens to them.
2
“that, like diabetes and heart disease, is caused by a combination of behavioral, environmental and biological forces.”
Your author may know something about addiction but safely nothing about diabetes. Nobody knows what causes type 1 diabetes, no one. And to suggest that we T1s are responsible for our diabetes is an insult.
If you meant T2, is it so difficult to say so?
2
Actually, recent research into what we commonly call Type II diabetes has revealed that it is a much more complex disease process than previously thought, with a much larger genetic component than has been previously acknowledged, and may be comprised of as many as five subtypes, some of which really cannot be simplistically lumped together as "lifestyle" diseases.
I was diagnosed at age 49, my 5'11" frame having never weighed a pound over 165. I ate a reasonably healthy diet, and was very physically active. I have what some are now calling diabetes Type 1.5, in which my body simply no longer produces insulin (or very little if it).
Maybe the wiser course would be for ALL of us to admit we don't know as much about others illnesses and disorders (including addiction) as we like to think we know, and take a stance about these disorders and diseases that is a little more rooted in compassion and humility, eh?
2
Prohibitionists are criminals. Society, their victim.
We are all forced to pay a terrible price for the "Holier than thou" sanctimony of prohibitionists.
How many would still be alive if they only knew what they were purchasing? How many would be educated if prohibitionists had not diverted vast sums of money to a monstrous prison system, in order to satisfy their hideous needs to punish others?
Addiction is not a disease, it’s a business, a three legged stool encompassing big Pharma (see Purdue Pharma), the prison-industrial complex and the for-profit rehab and medical industry. This is the new American exceptionalism. Addiction for fun and profit!
1
There's no such thing as compassion in the legal system. It only sees the results of addiction. Getting to the root of the problem is the answer. Without compassion all will be lost and the viscous cycle will continue. The latest fashionable remedy is to legalize such things as marijuana. While they're at it why not legalize prostitution too. It's not as far fetched as it may sound. It's coming.
This story is a big fat lie, as though "relapse" is some special form of victimization upon a person otherwise in good standing vis a vis their chemical abuse. Addiction to hard dope is a permanent state of affairs, you don't "become clean" in any substantive way any more than a person needing to use a bathroom, but is forced to wait, "no longer needs to go" but then "relapses" when the lavatory becomes available. The victim is the new user turned on by an experienced addict or dealer friend. It is NOT the addict.
Junkies make dealers rich, dealers kill you kids. The motive force for this cycle is the almighty dollar we worship, and the junkie. Junkies keep dealers alive & in business by buying dope. Nowhere in this scenario is there a side road where junkies turn off and go become superb citizens. They don't work, they don't pay taxes, and their behavior gets people killed.
That sounds harsh, but it's pretty clear that most writers on the subject are talking out of their hat. Please read this authoritative explanation on the history and permanence of hard drug addiction:
Licit and Illicit Drugs by Edward M. Brecher
http://www.druglibrary.org/schaffer/library/studies/cu/cumenu.htm
3
It's not necessarily either/or - addiction can be both a disease and the basis of criminal behavior.
The addict is expected to take responsibility for acknowledging and managing the condition. So if the addict "relapses", by way of, say, stealing to acquire illegal drugs, then the addict will be punished for criminal behavior, and treated for the relapse.
Having a disease, mental or physical, does not automatically create a license for illegal behavior or a get out of jail free card.
If the courts rule that repeat behavior is the standard of addiction then the government, state and federal, must apply exactly how many times repeated behaviors are excusable. Will it be 2 or 4 or 8 or 16? This is important to determine. Maybe 7 then?
Consider the heptagon:
Lust which covers everything from sexual desire to power to wealth.
Gluttony which is the same as lust except it applies to food.
Greed, again the same except it also adds publicly recognized accomplishments.
Sloth, which defines itself but actually means one doesn't contribute to the welfare of their neighbors or their greater community.
Wrath, which pretty much would cause many thousands, if not millions of drivers to be jailed.
Envy. Sorry, I just can't imagine any single thing that this doesn't cove for any human old enough to crawl.
Pride. So much for declaring to anyone how good you are at anything or taking a bit of self-congratulations when others determine you are a good person.
Under the terms of this article, Anthony Weiner should have been excused for filming his weiner to under age girls a few more times. Harvey Weinstein would be excused how many times after being caught?
I suggest the Editor who wrote this article research what is defined as addictive behavior instead of selecting one behavior to excuse. Once the courts address addictive behavior as being excusable, even if they address only drugs addiction.
Scary road down which you travel.
What landed Ms. Eldred in court to begin with was theft. Let me see if I understand this: if someone who isn't an addict steals and is caught, they are incarcerated, get probation, do community service, etc. The point is that stealing is wrong and the thief must pay for her crime.
But if the thief steals because she is an addict, she shouldn't be punished, because, you know, jail is harsh!
Ms. Eldred squandered her "get out of jail free" card. Hit the reset button, determine the punishment for the theft, and move on. I hope no matter the outcome of the appeal, she gets the help she needs and can stay clean. I also hope there are no other victims of her need to fuel her addiction.
4
The most educative and thought provoking headline I've read in a while.
1
Every addict is a drug dealer. That is a fact. In order to survive they need to buy drugs, hold drugs and sell drugs. Needless to say they need to use drugs. These “criminal acts” are inherent in drug addiction. Should we make it a criminal act to have high blood pressure?
Relapsing is a crime because thankfully our culture is governed by the rule of law, and not by pseudo social science or shrinks. If you want anarchy, move to Haiti.
1
Since personal responsibility, accountability and consequences from decisions seems to be all but absent from our "modern society" these days - "at this point, what difference does it make"? Alternatively, almost 100% of the people incarcerated for "abuse" issues go through "detox". Perhaps they should not be in the same prison population as murderers and rapists but still in a confined, restricted and punitive environment with help available for good behavior once they put on their big boy/girl pants and take personal responsibility.
1
It’s really long past time to let all of the non-violent drug “offenders” out of prison to clear space for the violent offenders. Make committing a crime with a gun 30 years and murder 50 years. I know a man who served our country in wartime and who was honorably discharged from the U.S. Navy who was deported from this country because of a drug crime. He had a drug problem. He was not a criminal.
I’m sensing the self-righteous hypocrites from America’s poor White hinterlands have finally joined the rest of civilized society in judging the War on Drugs an unqualified disaster. Incarcerating users and addicts does not work. But we can arrive at that conclusion without agreeing with the NYT’s dubious claim that the addiction debate has been settled. The fact is scientists have not identified a biological mechanism for the disease model. Treating addicts like helpless victims while downplaying their agency is a politically expedient argument for ending the War on Drugs, but at the cost of actual treatment.
2
1. At what point does the perpetrator of a drug related crime become responsible for his/her actions. We can't beat up on the victims forever.
2. Do changes in the law free the dealers from the legal consequences of their trade? Are they now victims?
1
If we made it easier for people, after they have relapsed, to get treatment, that could make quite a difference in recovery. If it is a disease, we need to figure out how to deal with it in an effective way. I don't think that shaming people is very effective, and I think that is one of the methods that we use.
I have mixed feelings about this. My daughter's ex-boyfriend became a heroin addict and began breaking into my house and into her apartment to steal things so he could sell them to feed his habit. He stole credit cards, our snowblower, cameras, ipads, even a car - you name it, he has stolen it from us. In addition to the stuff he's taken, we've had to install security systems and put locks on everything, including gates to our yards, etc. that under normal circumstances, we would not need. Despite this, he's only ever been charged with 2 misdemeanors for the 10+ separate times he's broken into our homes over the last 5 years, and that also includes the charges for other (unrelated) burglaries he's committed as well. They always consolidate his charges so he's only spent 3 months in county jail, though he's on perpetual probation. And he's not contrite at all. The last time I saw him I confronted him and he said "What do you expect, I'm a drug addict."
4
recovery from anything tough has a lot to do with available resources. so we need to more seriously talk about poverty and living wages and the availability, or lack thereof, of quality resources...quality resources are not equally distributed and have a lot to do with systems of class and racism.
I struggle a bit with the position of this article. I am a recovering addict and have been in sustained recovery for many years. I have a great life that I would not trade for anything. I do believe that addiction is a disease--with a bit of a caveat. When we are actively using, we do not think of consequences, only getting drugs. There is a time when that is no longer a medical issue and more a crime. If we continuously break the law--why is that not a crime? Doing anything for drugs often results in criminal activity. There are only so many chances a person should have. Jail can save lives. It saved mine.
It's a pretty simple solution--stop using drugs. It's much harder to actually do--but not impossible. Sure, medication assisted therapy is beneficial for some--but it is often difficult to access. There has to be some kind of better solution. More programming in jails and release programs that support people to get into a job, find a recovery program and get on with their lives.
I'm all about supporting people who are trying to recover--but sometimes we have to protect both them and others. Addiction is devastating to all involved.
7
The problem with a "disease model" for addiction is that it suggests that before people started substance abuse, everything was okay (as you're supposed to be healthy before you start to get ill).
Studies show, however, that the opposite is true. They were constantly overwhelmed by intense negative emotions (anger, fear, sadness, low self-esteem, low self-confidence, ...), and the only option that happened to be available to them was alcohol/drugs/... , because those substances are known for their calming, mood changing effect (at least during a few moments).
We will never get rid of addiction epidemias as long as we don't recognize this basic fact, and rather imagine that addiction is either a matter of mere "personal decision" (it is not, as has been proven over and over again), or a "disease", where the cause is supposed to be the drug itself (it is not).
We urgently need to accept that if we don't address the lack of self-care skills that allow an individual to handle negative emotions and comfort himself when they happen, nothing will ever change.
And nobody is born with highly developed self-care skills. We get trained in these skills by our primary caregivers (IF they were lucky and know what this means) ... or not.
For those who weren't, the only solution is to create situations that actively train them as adults (something that neuroscience has shown is perfectly possible). If not, there will always be relapses, as the root cause of the addiction will remain.
3
I feel ashamed and sad that I had never even considered that non-relapse cannot be mandated.
Is pedophilia a disease? Is it an addiction? You can see the problem. How do we draw the line? If people have an addiction that causes illegal behavior, at what point do we require those people to obey the law or be separated from society?
6
There's an argument that pedophiles et. al. should be taken to treatment, presuming they come forward before acting on their horrendous desires and permanently altering the life of an innocent kid.
More to the point, while it is impossible to say drug addiction doesn't have victims, it is more abstracted -- in essence, the addict only harms themselves (and the people who love them). This alone puts the "crime" in a far different league than an active pedophile.
2
We must not underestimate the value of a well-run county jail as a place of rehabilitation. In jail the addict is removed from both drugs and the drug environment, lives in a clean place and receives simple, nutritious meals three times a day. As an attorney I was often amazed at the change in clients after 60 or 90 days in jail. It seemed to work even better than voluntary inpatient rehab in many cases.
2
Almost anything mood-altering behavior that is repetitive and destructive can be labeled an addiction. While it truly is a disease, consequences must occur as to promote the diseased individual getting help and stopping the addictive behavior. There must also be a reason to avoid the addictive behavior to start with. While the brain is diseased, it does not remove our choice to do the next right thing and obtain help as to stop the addictive behavior. Sometimes, that means going to jail, if anything to prevent future harm to others from the behavior the addict may admit that they powerless to stop.
1
"The prosecution’s counterargument — that the disease model of addiction is far from settled science -- is weak."
And there is science to back up the incarceration model?
No, of curse there is not.
A deficit of science is what conservatives love, a good excuse for them to simply rely on fear and prison to solve a problem that has provably failed over and over to respond to such atavistic head-in-the-sand beliefs. Doesn't matter, because the only thing that really matters to them is to find an excuse for the state to punish. Somehow, they believe that the same state they believe incapable of making a good decision about a rich man's taxes (other than to cut them) should be given leave to make decisions about health that should be made be medical professionals.
The irony is that the most toxic and dangerous substances Americans use - tobacco and alcohol -- are (despite recent attempts to highlight their health consequences) lightly regulated despite their often fatal outcomes. Legal drugs do exactly what illegal drugs are often accused of -- kill and lead to crime -- but in far greater numbers. Is the solution for those problem illegality?
Obviously not, we've been down that road before. Let's quit ignoring the uncomfortable comparisons that should be made and adopt policies in the best interests of the public, the patient, and their families.
Agreed. But wrong. Try again. Addiction and addicts are the major destroyers of individuals and the communities they live in. Addicts steal from their family members until they are forced to leave home. Then in the community they often commit crimes of theft, drug dealing and vagrancy. The solution is to say yes it is an addition and yes prison is not the solution. The solution is to remove addicts from the community and create lock down drug treatment facilities. Prison cells don't work, but removal from the community and placement in drug treatment program that do not permit addicts to leave except for work and supervised visits will deal with the addiction as a disease reality and the reality that communities and families are damaged and destroyed by the criminal acts associated with addicts in the street.
3
This is a very disturbing story. We need treatment and not prison for addicted humans. When you think of Massachusetts think of witch trials. That defines the State.
Rehab treatment is a hoax (not to be confused with hospital detox). They charge $20,000 for a three week education program then instruct one to attend 12 step meetings which are free. If the patient doesn't really want to change (most don't) and does it only to satisfy a court, family, or employer requirement, it's money down a well. It's simply a method of extracting money from insurance and loved ones with the promise of 'fixing' an addict or alcoholic. If it worked they would offer a guarantee. Try NA or AA first - it's free and well worth trying.
2
Why is relapsing a crime? Because many do not think addiction is a disease. Again I urge readers to look up Portugal's experience with decriminalization. They have about the lowest opioid overdose rate in the West. This is a disease, but too many stakeholders want to keep it criminalized for profit. When the Times convened "experts" on the issue, none pushed for decriminalization. This will take a generation or two. Sad for the addicts of today.
3
This is a good idea, because it would cut the legs out from under the heroin trade.
It's not a disease. I've been through rehab and am sober for +16 years. The disease model provides addicts with a ready excuse. It takes recognizing your problem and a desire to get sober. Period. Rehabilitation is restoring something that has been damaged to its former condition. Stop drinking, stop doing drugs ...... there you are, restored. It's not difficult, but it's very, very hard.
2
It is a disease. You just had an easier time managing it, so congratulations, and you are lucky, it is indeed up to the will to decide to fight the disease instead of collapsing into shame. It took me several tries, and I had every desire to get sober and stop the ruining of my life, and until then, obtaining alcohol was--in my alcohol-wrecked brain--the same as obtaining. But until I understood the disease mechanism, I couldn't understand why my will was not enough. The prescription drug naltrexone helps. Staying sober is easier than getting sober and I was lucky I had health insurance and remained housed and had social support from family and friends. If I were living in the street, or punished by the criminal justice system, I don't know how I would have done it. Do we jail Type 2 diabetics if they can't stop eating sugar cereals and fast-food hamburgers every day? Sorry, your individual experience, as mine, does not constitute science. Look at the research. If anything, our criminal justice system as a mechanism of control by fear of imprisonment has not helped reduce the number of drug addicts.
1
Even better, do a medical detox, skip rehab and attend 12 step meetings for free. Nothing works unless one has a desire to stop, so why waste $20,000 finding out if one even wants to get sober?
2
I did. I love AA. It is an essential part of my recovery. But I had to reckon with the mechanism that impaired my choice for so long. Until the disease sprung up in my later life (I was a normal drinker with no problems with alcohol until my 40s), I had never had ANYTHING that interfered with my free will and control over my mind and body. It was as frustrating as having a cancer diagnosis, but I could not "stop" it without medical intervention, even though I could see how I was only harming myself, but the drive for alcohol felt the same as a need for food and water, which is an essential biological mechanism gone haywire. Getting rid of the shame of this was key to enabling myself to take the responsibility to get help and treat my disease. The fear of being labelled an addict was the very thing that kept me from getting help for so long. I am so glad that you could boot strap it and get yourself out, I know thousands of addicts indeed do that every day. But it is not good advice for creating health care policy, and it is not science-based.
Why don't we enact laws against law enforcement officers who overlook the heroin trade. Pinning the criminal penalties on addicts is like tying people with mental illnesses to bedposts. We need to get to the bottom of the problem--the criminal activity that's putting these substances out on the streets. Yes, you can fault big pharma for creating part of the problem but I would not say it was their intention to deliberately cause addictions. There needs to be more pointed legislation against the organized criminal activity that profits from creating addicts on the street.
1
That people believe it "isn't settled science" that addiction to opiates is a disease, suffer delusion. It may be a common one, but's it's little different that denying climate change.
Addiction modifies neural circuitry, and does so insidiously, as soon as opioids are used. People who suffer depression - also a disease - and other disorders may be more prone to start. But everyone goes through pain, and may discover the relief legal and illegal drugs bring.
If an organism infected human brains and rewired them the way opioids can, not one would hesitate to call it a disease. But because drugs are self-administered, the same rewiring is considered a choice. Ironically, from an evolution perspective, plants like heroin poppies adapted to infect people, as a way to thrive. Companies like Purdue Pharma followed the same strategy.
One thing to remember - unlike so many criminal justice issues, this one really isn't class or race based. The smug Prosecutor is just as likely to find their son or daughter addicted, as any of their defendants.
Last year more people died from opioid overdoses in the US, than the number of people who died from SHIV in any single year. So where's the opioid Act-Up? While leaders mumble about treatment, where's the demand for a cure?
There's little difference in criminalizing addiction, than criminalizing HIV status. Some countries were stupid enough to do the latter. We're stupid enough to do the former.
4
Your example of a brain infecting organism is appropriate but think about it: People with highly communicable infections that pose a danger to society such as tuberculosis, Ebola, etc. are isolated or quarantined until the threat has passed. Active drug addicts are disasters to other individuals and communities. They need to be separated until they no longer are dangerous.
1
Psychopathy is a disease, but acting on psychopathic thoughts is still a crime. There are lots and lots of criminal acts that are driven by mental illness. We still don't allow them, because of the harm to society, not because of any moral judgment.
3
Because addition is not a disease. It is a choice.
4
They were not in jail because they were addicts, they were in jail because they did a crime. To shorten their sentence they agree to parole and to stay clean. Get caught using and back you go to finish your original sentence. The deal is rather simple, some will make some will not. Society has the right to require you live within the law of you want our sentence reduced.
4
Drug addicts belong in rehab, not jail. Addiction is a disease, not a crime. Punishing the victims of this disease only exacerbates the effects of addiction and makes recovery all the more difficult.
But the place to start is changing the draconian drug laws in the US, beginning with the legalization of marijuana, hemp, and all associated products. Other nations, notably Portugal and the Netherlands, have shown us how liberalized drug laws actually reduce the level of addiction and related criminal activity.
The problem is we are run by people who think it's still 1963, when gas was cheap, black people stayed in their own neighborhoods, American cars were the envy of the world, gay people "didn't exist," and drug addicts were simply criminals (and of course typically people of color).
Time for a criminal code reboot. If we want to improve our way of life, we must be willing to abandon policies that prove ineffective, and that are the cause of so much suffering and death.
10
Lots of drug addicts leave rehabs against medical advice or violate rule in the rehabs, get into fights with other patients, etc. Can we send them to jail?
To answer the question posed in the title of the editorial, because drug abusers pose a serious danger to innocent people. Criminal law and criminal penalties are meant to deal with exactly this situation.
Contrary to the "pity me I have a disease" meme, drug abuse is not a victim-less crime. And the crimes are often violent. Within the last year, our small community has seen a drug-addled driver kill an innocent high school student in a head-on collision. A drug dealer murdered an informant by shooting him in a public place. We've had numerous robberies and break-ins by drug abusers looking for cash for the next fix. Our volunteer fire department, police and other first responders are put at risk on a regular basis when they're called to home meth labs.
Before agonizing over how to help drug abusers with their "disease", let's do what civil society is supposed to do. Protect the innocent.
PS: And please give us a break on the "disease" thing. Should murder not be a crime because many murderers --who fall several standard deviations away from the norm on measurable behavioral guard rail metrics such as impulse control, susceptibility to sudden rages and the like -- have a "disease"?
7
As long as I'm not driving there, I love Massachusetts.
1
Most addicts aren't in jail for drug use They choose to commit crimes to fund their drug use. When the court orders them to stop using drugs, it is dealing with them as criminals.
I read recently that one in ten people are under 80th percentile in intelligence. And there are probably personality types that are far more prone to drug abuse than others. But what is so wrong with jailing people who are unable to control their own drug abuse related criminal activity? It is more likely to keep them alive and healthy than letting them run free while abusing drugs and other people. Perhaps we need to open work houses for drug addicts.
1
In answer to the title's question, in California v. Robinson (1962) 370 U.S. 660, the Supreme Court held that it violated the Eighth Amendment to punish a person for "being" and addict. In the same breath, the court stated that it was of course permissible to punish a person for "doing" the things addicts do -- e.g., possess drugs, shoot up etc.
The question really is: when will the American judiciary relapse into sanity.
1
The part of the equation that this article misses is the cost. If we could pay $6,000 to cure someone of their addiction, the government would have started doing so long ago. $6,000 per year is the long term, maintenance costs of MAT. The costs of an initial, comprehensive treatment program are often comparable to the cost of a year in prison, but only have a success rate of around 10% - 15%. The end result is that it's cheaper to incarcerate than it is to treat. The core problem is that our treatment options are very expensive and modestly successful at best. Until we develop better treatment options, nothing is going to change.
1
People don’t go back to jail for relapsing. They go back to jail for committing crimes, e.g., robbery, assault, breaking and entering, while relapsing. I noted in the article the phrase “relapsing and other violations.” What do you think those violations are? If police bust people for simply being addicts, that does not seem a wise use of resources. At the same time, addiction is not an excuse for other crimes.
6
"Why is relapsing a crime?"—
You must be very careful with the broad brush of the word "addiction".
What if I'm "addicted" to money and I "relapse" and steal. Or, in the current cultural accountability awakening, I'm addicted to sexual harassment or worse, and relapse after my "rehab".
Or, I'm addicted to any of a number of things, not just drugs.
4
As an intern dealing with clients of two of the toniest rehab centers in NYC during the nineties, I witnessed the dawn slowly rise in the best minds in the field, the expectations change from pure abstinence to allowance for relapse, maybe several.
Among other Great Thoughts: "If addiction is so great a problem it threatens civil society and crams our prisons full, how rational is it to think our clients will change their lives just because we say "Don't do that!" with our stern faces on?"
Success rates improved and recidivism decreased.
The biggest obstacle to wider-spread implementation of such thinking? People like commenters here who just want to punish. People who can't tolerate the thought of someone who isn't them getting some sort of "break".
Moral champions who, knowing their lives are exemplary, demand the same from from everyone they encounter and ruthlessly enforce their terrible judgement (until the day they or theirs are found out, "What!? My son is gay? Compassion! Compassion, I say!")
Here's the bottom line, recognizing no single intervention is a cure-all: you can make people, and society, healthier, or you can have your righteous vengeance. Pick one.
If you, as you will, opt for vengeance, than I demand you begin by sending pharmaceutical executives, bought politicians, and your neighborhood pharmacist to jail. Take all their ill-gotten profits and dividends and invest them in treatment. Just to get the ball rolling.
9
Jail is good business. Big pharma is also good business.
Welcome to corporate America, where millions of people, mostly black and brown, are kept in jail for non-violent offenses, and millions of dollars are made in profits each day.
Our authoritarian, militarized, violence-oriented, racialist system seems unstoppable.
Disinvestment in human capital is rampant, while investment in financialized capital is on the rise.
Who says the system isn't working? It's working beautifully for the very rich. The fact that it isn't working for the rest of us is irrelevant to those in power.
oz.
1
Missing in all these pity articles for drug addicts is the massive criminal harm they do and why they definitely belong in jail. Drug addicts are narcissists who have zero regard for anyone but themselves. It is why they will do everything from stealing to selling their own children.
We send drunks on probation who relapse or commit crimes to jail and the same should be done for drug addicts. Their relapsing is not done in a vacuum. It involves babies born with serious medical problems, children neglected or living in dangerous conditions, crimes committed to get their next hit and various other criminal acts. Addicts are like typhoons of destruction.
4
In possibly as little as 20 years, we're going to look back at how we treated people struggling with addiction, and its going to read like a prescription for leeches and bloodletting.
2
Actually leeching and bloodletting is used in modern medicine. http://sciencenetlinks.com/science-news/science-updates/modern-leeching/
Aside from the heart rending stories about the addict who started on the journey because of a broken leg and a doctor's prescription, most addicts start because they choose to. There is no logic to having not enough money for food so they decide to spend what they have or can steal on illegal drugs. The difference between an alcoholic and drug addict is that alcoholics don't break the law by buying their drugs. Drug addicts chose to break the law. That is what makes them felons and should be treated as such. Not only did they chose drug addiction, they chose a dangerous path of not knowing what they are buying. At the liquor store the product is what it says it is. Jail should be a good place to detox if there are more safeguards against visitors and guards bringing in drugs. Even though most of the addicts whose stories we see are white, they are still criminals. The excuses are psychobabble.
6
Your argument is circular: they belong in jail because it's illegal.
Drugs are bad news people. Just say no. It will reduce the number of articles that have to be written about the misery they bring, save a lot of tree paper and improve the environment all at one time. No one should be advocating that doing drugs is ok. It's not.
4
...because these are primarily people of color, who are arrested for this "crime," and prison stockholders want to get paid. Private prisons are like hotels, that don't make money unless they are filled with "guests." And, everybody down the line, in the system, needs to get paid. And, cops are villains, when it comes to these people.
If Addiction Is a Disease, Why Is Relapsing a Crime?
Uh, maybe because addiction isn't a disease?
5
Addiction is not a disease, it's a compulsive behavior.
5
Why would the cimoninal justice system use the same definitions as the medical proffession. Sure it might be a medical problem in many ways but what does someone who commits crimes like robbery and aggrevated assault to get their drugs. Not in your neighborhood? How about your drug dealer? Does he have a firearm? Does he start shooting when the cops kick down his door? Should the guy with a medical problem that mugged my grandmother go unpunished? Relapsing into an addiction may come with more than a one crime.
You say ban guns and legalize drugs. That simple. I suggest a little more thought and research. At least you might have the reason why law enforcement is draconian in high crime ares than where you live.
The problem here is our notion of personal responsibility.
Everybody who has met people with an addiction knows that once you're addicted, mere willpower isn't enough at all to get rid of it.
And being addicted is already a punishment (as it destroys your life and health even more than imprisonment could ever do), so adding imprisonment without any treatment, or threatening to imprison after a relapse, won't change anything.
We will only be able to solve the addiction epidemia once we accept to take responsibility for what happens in our society AS a society.
The disease model being the only model available today to refer to the fact that just like in case of a disease, you cannot just "decide" to get rid of it, you also need a proper treatment, it does make sense to call addiction a disease.
But it's quite obvious that what makes people become addicted in the first place is NOT comparable to a disease, in the sense that there's no external physical entity entering the body and making you ill. So it will always remain possible to contest the relevance of the disease model here too.
What we urgently need is to FINALLY admit that human beings don't merely need food and shelter, but also LOVE - love as a verb, and a condition sine qua non to develop practices of self-love, including calming negative emotions (= THE main reason why people start substance abuse).
Many social environments don't provide this, and that's where we as a society are responsible, NOT the victim.
7
Why are prescription opiates not taken off the market? Because millions of people need them for pain control, particularly in recovery from surgery. For many people opiates are a blessing which allow them to live more or less normally. Would you deny pain relief to those who need it? It is true that addiction has become a huge and deadly problem. But, it is getting increasingly difficult for people who really need opiates to acquire them.
6
The truth is that more than 80% of people use opioid pain medication do not become addicted and do not OD or move on to illegal drugs, that is unless well intentioned laws take away their legal pain control.
We are dealing with a Stalin Statistic here. Losing your loved one is a tragedy, but 2000 lost is nothing but a statistic as are the 8000 being able to live a more normal life (numbers are for an easy to follow example only). Overdosing deaths are increasing because of the current laws and prescribing and insurance "rules". Deaths will continue to increase until we put an end to these deadly laws and restrictions.
3
Whether or not addiction fits the definition of a disease is not the issue. Whether it should be a crime, is.
I say no. Jail is no place for addicts. They need treatment, not punishment.
If addicts commit crimes, they must face the legal consequences of their acts the way non-addicts would. But treating the addiction itself as a crime is not the answer. It is a health issue and if it is to be addressed effectively, it must be done by health professionals and others outside the realm of crime and punishment.
15
- People who are addicted still need to be accountable for criminal acts, however our goal as a society is to get addicted people into treatment. Even for minor infractions, it seems we aim to get them into jail rather than into treatment.
- More specifically, the corporations who liberally promoted prescription opioids need to be held accountable for a wave of addiction that escalated to more potent substances, and contribute to the cost of treatment and support programs for people addicted to opioids.
- promote the use of medication-assisted treatment and make it more available and covered by insurance.
- Increase the options and providers for effective treatment, and monitor and rate these programs for outcomes and effectiveness. Our society needs to know which treatment programs work best and replicate those models across the nation.
2
Addiction is a disease and so is it's relapse. If a crime is committed by somebody addicted to a given drug may require restraint and/or prison, but still remain under treatment. Justice is one thing; common sense, another; and they ought not be incompatible.
1
There is something inherently wrong with the way we in the West came to see criminal behavior.
Since a couple of centuries now, we started imagining that to behave in a morally responsible way is somehow a mere matter of personal, individual "decision". So when someone behaves badly, that person took the wrong decision, and in that case the only thing left is to hurt him/her so much that EVEN though personally they WANT to behave badly, they also want to suffer less so they stop doing so.
As we all know that things aren't that simple, though, we invented the notion of mental "disease" in order be able to explain why certain types of anti-social behavior seem to happen even when it actually destroys the criminal's life more than giving him/her any real pleasure. Because after all, a "disease" is NOT something you decide to have, but something that happens to you.
Unfortunately, "disease" refers to a physical condition inflicted through a physical entity that is detrimental to your health and invaded you from the outside, and that you have NO decision power over at all.
Many mental conditions, however, ARE the result of interactions with the outside world, but have to do with psychology, not medicine.
In order to thrive, human beings need very specific interactions with other human beings. Absent these, they get overwhelmed by negative emotions, and THAT's where substance abuse brings some temporary relief. If "disease" there is, it's that absence, not abuse in itself.
1
The science on addiction is anything but settled on it being a brain disease. The reason the disease model persists as a settled explanation has to do with many different factors besides what the science indicates, but using this as the pervasive model has significant, and in my opinion, negative implications for the treatment of addictive disorders.
Regardless of what model of addiction one uses to understand serious substance abuse problems, most people would agree that it is a persistent and devastating problem for the individual, their families and friends and society as a whole. When we limit ourselves to seeing addiction from the disease model, we also limit the treatments and solutions that are made available. The disease model tends to result in myopic solutions when a varied and personally tailored approach may be more effective. There are some good findings psychological treatment outcome research to believe that treatments need to be constantly adjusted to what is happening with the patient to be effective. The disease model does not naturally support this type of treatment approach. It tends to provide biological solutions that are applied in a paternalistic manner with little patient input.
The disease model also proposes the idea that the brain is dysfunctional in some way. This leads to an overemphasis on biological as opposed to psychological and sociological based interventions thereby likely negatively impacting treatment effectiveness.
3
This case also has the potential to generate some unintended consequences. If prosecutors and judges are worried about crimes committed by relapsing addicts, but can no longer employ drug testing, they may be more likely to seek imprisonment instead of probation for low-level offenses, especially among repeat offenders.
2
Addiction is not a disease. Addiction should not be treated as a criminal act. It's a health issue.
a better question is "if prescription opiates act on the same receptors as street drugs e.g. heroin, synthetic fentanyl, why are prescription opiates no taken off the market?" If a prescription drug had the side effects of contributing to a death rate more than all deaths from motor vehicles, more deaths than from breast cancer - wouldn't it be immediately taken off the market? What's up with the FDA? Am I missing something here?
4
Drugs have side effects and dangers ... all drugs.
All drugs can kill you. All psychoactive drugs are addictive. If it's not addictive, it's not psychoactive. Period.
Medicine isn't about doing *no* harm. We simply aren't there. Medicine is about *limiting* harm.
If a patient is in so much pain they will kill themselves they need pain relief, even if that pain relief also poses a threat to their health. As a doctor your job is to find a balance, choose patients with the most need ... keep patients that enjoy the most benefit.
Likewise the role between opiate prescriptions and the current crisis are way way overstated. Cancer patients, spinal cord injuries, and others with intractable pain are not addicts *regardless* of how they relieve their pain.
Ultimately they have become the *biggest* victims in this crisis with doctors abandoning them to suicide or a life far worse than any addicts'.
1
The one important word in your editorial is remission used in this context. I have never seen it used this way. It is a good choice of a word because it describes the process of addiction recovery in medical terms. My other thought, and one that happens often, why in America do we have a propensity to throw people in jail whether it is necessary or not? Americans hate paying taxes but would rather pay $33,000 a year rather than $7000 so we can punish people whether they are addicted or mentally ill. We need to become a more compassionate Nation and as an incentive, if we need one, compassion is less costly.
7
Why? It's because for decades drug addicts were portrayed as only being black and from the inner cities. Drug addiction in white suburban communities was well hidden. So the mantra was lock up drug addicts. Now that it is harder to hide white drug addicts it is suddenly a disease.
I am tired of people pretending they don't know why.
Well, true. It would be cheaper and probably more effective to treat rather than incarcerate. But the fact remains that with the privatization of prisons, there's a lot more money to be made off a $33,000 annual prison stay (per inmate) than off a $6,000-7,000 treatment program.
Call me a cynic, but I used to think that decisions were made considering social and individual welfare. Now I realize it's all about "follow the money." Don't worry about the individuals themselves.
It's a complicated problem with many components (cultural, social, psychological, dna level and neural circuitry/neurotransmitter levels).
Yes, addicts should receive treatment, but they need to accept responsibility for making choices (taking drugs initially) that led to new neural pathways and brain re-wiring.
Redefining your purpose and engaging one's willpower are essential components to real change too, as is medical treatment and counseling.
You have to strongly not want to be the person dependent on a substance, and that's hard work.
As one former addict said "An addiction is powerful, but it can be overcome with the right mindset, coping skills and your own desire to change."
If someone is an alcoholic, drives drunk and kills people in an accident, we don't say you have a disease and bear no responsibility. Someone relapses and robs people to buy more drugs is also responsible and should not simply be given a pass.
Personal responsibility, treatment and consequences for wrong choices are all necessary, and it takes a lot of wisdom to figure out the right mix. But it is not as simple as "I have an addictive disease, so I'm not responsible".
7
Response to comment by dre: I've read your comment and it's made me stop and think about our Judicial system. As you say, "Yes addicts should receive treatment, but they need to accept responsibility for making choices (taking drugs initially) that led to new neural pathways and brain re-wiring." On the other hand why criminalize the taking of drugs if no violence or crime was committed, except taking the drug(s). I have a feeling that the war on drugs is more about the greed inherent in the system we created, private prisons, fines that are used to run the court system, profits of bail bond businesses, etc., the attitude that someone has to pay, seems to be the rule more than any rational policy based on offering medical, psychological and social help and programs for the addict. Having viewed the US court system I can tell you one thing's for certain, it's financed by the poor and it's a system that in many cases offers those who can afford a good lawyer, a chance of doing little or no jail time. Doubt me? Just look at the statistics of those citizens being incarcerated. We, as a people, need to start to evaluate the mess we've made by placing the chase for the all mighty dollar ahead of the being of our citizens. Those with felonies are their records are stigmatized for life. Is there anyone who agrees that placing an addict in jail with a group of other addicts with little or no treatment is a rational idea that will help the addict upon his or her release?
I did not read this opinion that way. What this opinion discusses is the criminalization of someone out on probation for a crime who relapses without an accompanying crime. The relapse alone sends them to jail....and then going to jail thwarts their recovery because MAT is not offered....
1
Canada has many versions of what are called "drug courts", where addiction related crimes can be streamed if they meet certain criteria. Relapse is accepted and incentives are in place to discourage it, but if you admit to your relapse you are not put back in jail. If you try to deflect or lie about it, you'll go back in for a short time. So most people admit their relapses, get more intensive interventions and lose some privileges but not the right to be out of jail, and many come out the other side with effective treatment and a suspended sentence. It's not perfect, but it's better than punishment at all turns.
18
Taking away people's mental or physical health should NEVER be part of a punishment in a civilized society, no matter what crime they committed.
And imprisoning victims of addiction again when they have a relapse is even more absurd, once you know that there's no treatment in prison available at all - and for many people, no treatment available outside of prison either, whereas most conditions that led to their addiction are still there, or even became worse because of their imprisonment (increased contact with felons and drug dealers, less chance to get a job, even less positive role models around so higher chance to incorporate a way of living and behaving that lacks high moral values, etc.).
As Julie Simon shows in "When food is comfort. Nurture yourself mindfully, rewire your brain, and end emotional eating" (a book about eating disorders but that, as Simon reminds, can be applied to any form of addiction), using substances or "comfort food" is something people do when they're overwhelmed with negative emotions and don't have the self-care skills installed that are needed to sooth and comfort themselves.
And the reason why this "Inner Nurturer voice" hasn't been developed is because they've grown up with people who never learned so either.
So first putting them together with other felons and then sending them back to their previous world won't change anything for them (quite on the contrary) - and it certainly won't make society safer either.
1
Cancer is a disease not brought on purposely.
Addiction is a choice brought on by the decision of the junkie.
It truly IS that simple.
Don't confuse the two.
13
No, it's not that simple at all.
Nobody smokes each day IN ORDER TO get cancer. The exact same thing goes for alcohol and so-called "hard drugs".
There's absolutely nothing interesting in being "addicted". What smokers, alcoholics and substance abusers rather seek is the emotional relief that those products provide. They often don't need this kind of relief each and every day (especially not in the beginning), but these are substances characterized by the fact that they create a physical need for more which mere willpower cannot possibly eliminate or fight back against.
That's why the only solution for addiction is:
1. to provide a therapy that makes it possible for the body to transition to a drug-free way of living.
2. to provide a training in self-care skills that allow addicts to detect and handle negative emotions without needing any substance anymore.
Conclusion: what you're confusing here is the fact that we all do control "small decisions" such as will I take this or rather that sigaret, but we cannot possibly "decide" to get rid of negative emotions, so either we were lucky and got highly trained in self-care skills already during our childhood, or we weren't, and then substances may become the only way to keep your sanity rather than to for instance commit suicide.
It's because people want to live, and live BETTER, that they become addicted - certainly not to become addicted in itself. As long as you don't understand this, you don't understand addiction.
19
My immediate and extended family is riddled with drug and alcohol addiction, and I’ve lost two close family members to addiction. It is my observation that they quickly lost the ability to “choose” to drink very early in their addiction. Both took their first drink as young teenagers, as I did. I enjoyed drinking and did it often, but my family members had a pathological need to drink that I did not have. So while we all chose our first drink, it rapidly became something too powerful for them to manage (as powerful as the need to eat or sleep) and I believe the element of choice was quickly moot for them- it became a need. No one knows if that first drink or painkiller will start one down the relentless path of addiction; I believe people who are predisposed to addiction are often ensnared before they even know what happened. That is why I have educated my 14 year old grandson about the nature of addiction and our family’s addiction history, so he understands he is at high risk for it. Hopefully this knowledge will be in the forefront of his mind when he decides to take that first drink, whether he’s 14 or 24.
10
In your argument cancer also is a choice--eat not organic foods, smoke, don't wear masks on high pollution days, live near toxic environments --yep cancer is a choice, as much as any addiction (opiates, food, sex,etc)
Seem impossible to avoid? Yes it does.
Cancer and addiction are both diseases manifested by the world we live in.
3
Why is a moral line drawn between alcohol addiction and "drug" addiction?
Why are we legally able to obtain and even encouraged to enjoy any of tens of thousands of celebrated alcoholic beverages with no shame or scorn, yet doing a "drug" even once is accompanied by the real threat of jail time, shame and scorn?
Until all drugs are decriminalized and our resources aimed at abuse prevention and rehabilitation, our society and many others we will remain on our circular paths of failure.
43
Follow the money. Who benefits from anti-drug laws? The entire criminal justice apparatus: police, probation officers, prison guards, judges, defense attorneys, prosecutors (and the legislators who write laws are mostly lawyers). They'd criminalize alcohol were it not the national drug. Indeed coffee too, except that drug is the perfect complement to donuts.
11
Correction: ALCOHOL is a HARD DRUG. The beverage industry has somehow cleverly avoided the drug label it most certainly wears.
And this potentially addictive and deadly hard drug is one of the most promoted products in America - we encourage this hard drug abuse to the tune of billions of dollars in ads. Drunks who fall off the wagon do not go to jail - they go rehab.
This whole charade need to end - now.
Great editorial!!
11
Yes, alcohol is more dangerous than marijuana by any measure, but alcohol is legal and marijuana is still ridiculously categorized as a Class A drug.
Marijuana is not even addictive, but merely habit forming. There are no withdrawal symptoms.
The difference is political.
Prohibition was a failure, doubling the murder rate before it was repealed, and making the mafia rich and powerful.
The murder rate went back down again, but shot up when Nixon restarted the drug war.
In the nineteenth century drug use was common. Heroine was a brand name from the Bayer company. Coca Cola had cocaine in it.
The drug war didn't stop robberies. It just rewards criminals with drug profits.
Enough.
As a recovered alcoholic, this situation strikes a chord. Whenever my wife threatened divorce over my 24 hr. drinking, I'd throw the old wedding vow "in sickness and in health..." reminder at her. Finally fed up, she reminded me that I was responsible for taking the treatment available (AA) to manage my 'disease', or else face the consequences. After the divorce that I began to see her point. That was 15 years.
7
This editorial tries to paint drug addiction as a disease over which individuals have no control, and ignores the very important concept of individual responsibility. It is a mistake to consider drug abuse solely as criminal behavior, but it is also a grave error to ignore that fact that people have control over what they do, and need to take responsibility for their actions. This is particularly true when one considers the recidivism rate described in the article.
The deleterious effects of addiction are great. Addicts themselves suffer the most, but their families are also greatly affected. Many get the money needed to buy drugs from crime, often violent crime. The drug supply network helps fund terrorists, including the Taliban, and extraordinarily violent criminal gangs, both in our own cities and abroad. Much illegal immigration is a consequence of people fleeing drug cartels in their home countries.
Obviously, this is not simple. To advocate the concept that drug abusers whom society treats, only to start abusing again, have no responsibility for what they do to themselves because they have “a disease” is a mistake. I am not saying that jail time should be the dominant “treatment,” but I am saying we should recognize that, in most cases, people have responsibility for what they do.
11
Yes people have responsibility for what they do. No one in recovery will advocate that addiction is an excuse for what you have done and that you can not be held accountable.
Many non addicts do not understand the complex relationship between free will/choice and the addictive mind. Just don't have another drink is not so simple.
No one in recovery is ever given a 'pass' for acts committed while in the grips of active addiction. Having the disease of addiction has never been an excuse. This article is about the messy process of recovery which leads to sobriety hopefully and the full accountability of the addict for what they have done.
8
I worked in healthcare on rikers island for a few years. While the dominant narrative about the place tells about the violent prisoners, the real danger is that it is a hospital with limited treatment ability (the medical staff really do try, but healthcare behind bars is difficult).
The vast majority in one of the country’s biggest jails are mentally, chemically, or physically ill. The $33,000 figure that everyone keeps mentioning assumes a healthy prisoner, btw. It’s more like $45k.
I think we need to re-examine the idea that we can force people to hit bottom with incarceration. For a lot of people, there is no bottom. Making their lives worse just makes their lives worse at taxpayers’ expense.
Using jail and prison to manage our country’s drug problems is wrong.
35
The financial part about jail costing 33k and MAT 6k answers why we still criminalize drug use. It is more profitable to keep it illegal and penalize users. So there is the 'why'.
4
Greed is something religions and philosophies warn us against. Corporate persons addicted to greed is a major reason our country is failing to live up to its potential as we read and write. Mind altering substance use to relieve emotional and physical pain is increased with the abusive policies that criminalize those substances. Creating a better world for everyone is not the intention of the corporate persons responsible for these society destroying policies; they want it all so we need everyone strong and off drugs to fight these society destroyers.
1
It is not only addiction that all too easily results in criminal charges but also mental illness, depression, alcoholism, and even physical and mental handicaps.
In Pennsylvania the Republican dominated state legislature closed PA State hospitals, wrongly insisting that the patients would do better in private hospitals, home environments or even on their own. The legislature claimed, wrongly, that state hospitals were no longer necessary and were outdated and out of touch with the needs of families and patients. The result was catastrophic. Families found themselves unable to care for those who were severely disabled or mentally ill. Worse, state courts were no longer able to place people charged with drug abuse or other disabilities into treatment centers and instead were compelled by law to issue prison sentences. The result was greatly over-crowded and understaffed, as well as underfunded prisons who were ill-prepared to handle medical cases. Staff and administrative personnel didn't have a clue what to do with people who suffered medical conditions. Too many former patients of state hospitals suddenly were criminals. Those incarcerated who were mentally ill or physically and mentally handicapped had no understanding of what was happening. And they could not defend themselves or communicate what was happening.
It is not only relapsing that is a crime. Our legislatures have created a new class of criminals; Mentally ill, addicted, physically and mentally disabled.
24
What I find troubling, very troubling is that I have to the NYT many times about the critical issues of over crowded prisons, wrongful prison sentences, injustice for the mentally ill, physically and mentally handicapped and those suffering from drug and alcohol addiction. Not once in the past 15 years has the NYT ever responded with timely editorials or, god forbid, an investigation and factual reporting of how too many Republican dominated state legislatures have destroyed the lives of tens of thousands of needy citizens while touting tax savings for the citizens of those Staes. Self reliance is not a cure for mental and physical disabilities. Austerity and impoverishment is not a cure. Imprisonment is not a cure.
6
Jay,
I agree with most of what you say but I should point out that it isn't only Republicans who do this. In New York, Mario Cuomo took the money that the state got from selling off the real estate when it closed state mental hospitals and that was supposed to be used for funding outpatient mental health facilities and used it for funding other things completely unrelated to this. And one of the first things his son Andrew did when he became governor was to cut funding for mental health care in the state.
And in that other bastion of Democratic liberalism, Gavin Newcome, the Lt. Governor and likely Democratic nominee, and current Governor Brown have both denigrated psychiatry and sought reduction in funding for mental health out there.
Sadly, in this divided country one of the few things Republicans and Democrats agree on is that we are always spending too much money on the mentally ill despite every study that has stated the opposite is true.
3
See Nicholas Kristof’s column on 9/22/17 about drug treatment in Portugal where apparently it has worked to divorce it from the legal system. If this works as well as presented why are we not at least considering and studying a complete retooling of our own system? Never mind. I know the answers. If it’s not American it’s inferior. It’s too offensive to our preconceived Puritan attitude of “bad” behavior has to be punished. And the money would actually go to help someone instead of an out of control legal system. (I just love the new trend the Times reported on prosecutors going after co-users or family members of users. Then too nothing helps an addict rebuild his or her life more effectively than a nice felony conviction on his record. )
31
Yes. Thank you.
There's so much morality tied up with the use of substances, and yet if you look at them through the lens of a disease, there is zero justification for blaming the people who can't control their use. By definition, they can't control it. You might as well blame a cat for having fur.
3
All behavior is a product of the biology of the brain. Perhaps that leaves us with a dilemma in terms of the legal system and moral reasoning, but the dilemma can’t be resolved by denying the realities of biology.
6
Jail cannot solve emotional or mental problems. Jail could solve production of addictive drugs. For each death due to products of Big Pharma's inventory of addictive drugs, one employee of Big Pharma does 5 years jail time and the company pays a $1,000,000 fine to help with recovery programs.
6
How do you separate the criminal acts from the addiction they are committed to support? Count child neglect among the crimes. Who picks up the tab for the drain on resources addiction causes our society? There has to be a point where society gets to say enough! We hold people's feet to the fire to pay back student loans but can spend far more trying to rehabilitate and addict, only to have them relapse time and again. I strongly advocate rehabilitation programs as opposed to prison; particularly those that keep the addicts in familiar surroundings. However, addict or not, perpetrators must be held accountable for their crimes. If punishment includes prison time so be it. If we need rehabilitation programs concurrent with serving time, that should be arranged. We will also need separate rehabilitation facilities which restrict the free movement of those that repeatedly fail rehabilitation.
5
Because we are and always have been alright with criminalizing aspects of disease behavior that negatively impact society.
There is the justification that it incentivizes recovery and treatment. I've certainly seen several people 12 step only after a criminal "bottom".
Beyond that, there are behaviors that are shared between the addicts and the non-addicted users and those distinctions are better addressed in sentencing and discretionary prosecution than in lax criminal codes. I'd offer that improving the judicial's ability to engage in long-term treatment and support services does potentially the most institutional good for those with severe AODA issues manifesting in criminal activity.
1
Treatment costs less than $10,000 a year. Incarceration costs $33,000 a year. That's why we're doing it this way. Too much money is at stake, and cops and judges and lawyers and prison guards and politicians who enable and profit from the whole shebang like it this way.
2
What treatment costs that little?
I wasn’t aware that addiction had been criminalized, so the notional criminal nature of relapse had never occurred to me as an issue to be parsed. Whom do we put in prison for the original “crime” of being an addict?
We go after drug DEALERS, and jail them when we convict them, but addicts? How much effort is expended to corral THEM? And we go after people who commit crimes of property and of violence against others to TAKE the means to BUY drugs, but we don’t indict them for being addicts: we indict and imprison them on the same basis for their crimes that we indict those who commit the same crimes who are NOT addicts.
Surely the editors are not arguing that because they’re addicts, we should overlook their crimes of property and violence, or of dealing illegal drugs?
However, when addicts demonstrate a pattern of behavior that is socially predatory in order to support their addictions, it seems to me, absent a demonstrable way of supporting the addiction honestly, that society has both the right and the obligation to protect itself from future predation – by sending parolees back to prison.
I’m not at all sure that the Massachusetts case … has a rational case that is not pure, fuzzy-headed Kumbaya.
3
If addicts had cheap unfettered access to a legal supply of drugs would they ever need to resort to crimes of property to support their habits?
A monthly supply of heroin that costs an addict thousands on the black market would cost less than $50 if they could instead purchase it from a pharmacy.
Beyond that there's limits on access to work for addicts. Forcing addicts that would otherwise be happy to pay taxes and serve our society like the rest of us into a position where they are stealing not just to feed their addictions but to keep roofs over their heads and eat.
When you take away the black market opportunities to provide drugs for addicts there's also the benefit to society in eliminating gang violence ... and the struggle to control the market that explodes in war and violence not just in American ghettos.
When you take away the moral aspect of things and try and look solely at the crimes *other* than drug use and dealing the argument in support of continued prohibition is weak.
Just look out how violence and the black market supply exploded then disappeared during and after alcohol prohibition.
Look at the results in European countries that have taken a completely different approach in how they treat addicts. Switzerland is a prime example, having permitted the treatment of addicts with heroin maintenance programs.
They don't *have* a heroin problem or prescription drug problem, yet have *more* permissive policies and availability to anyone who wants it.
Anyone with a family member with addiction and mental health problems knows that relapse is one of the symptoms for both diseases. It seems that relapses are part of many human conditions such as diabetes,heart disease and even cancer (remissions). Although family members float in and out of accepting addiction and many forms of mental illnesses as diseases and relapse as an all-too-common occurrence, they slowly come to understand that to love an addict or someone with mental illness is a challenge and a transformative life experience. Acceptance does not mean closing one's eyes to
the consequences of relapse, but to understand it and change our own responses to accept the things we cannot change in a way that enables both family and patient to continue to pursue recovery.
1
And why is the need to test citizens for drug use a requirement for public assistance?
Either casual drug use and relapsed addiction are crimes against society or they aren't.
2
Would you give money to a panhandler if you knew he was going to use it to buy alcohol? Should public assistance money be used to buy illegal drugs? The same logic applies to both situations.
The assertion that drugs are a victimless crime may be erroneous. The children of drug addicts are seriously affected by the neglect of addicted parents who may lose custody of their children. At the same time, I believe that treatment is an answer and not incarceration. There will be lapses and the addicts may or may not be motivated by losing their children. It takes time for recovery and the child welfare system may take custody before the recovery is complete. The children deserve is to live with sober parents who can love and care for them.
4
Pain is the motivator for change for people with the various versions of alcoholism/addiction. I have never met someone who said life is great I think I will quit using drugs or alcohol or name your drug. It is pain that motivates them and jail is one of those pains, unfortunately.
8
Does it *have* to be though?
More-so is it even the most succesful path to freedom from addiction?
The answer the European model gives is is a resounding NO.
Heroin maintenance programs in Europe have produced better results than ... *any* other model. Users with stable lives when given the opportunity to do things with their own autonomy *still* choose to quit even when continuing to use HEROIN is FREE and provided by the government!!
2
You are correct --pain is n initial motivator. But in NO way does pain treat or move anyone towards healing. Jail in a short term, do no more harm than has already been done kind of way is useful (we're talking really short term here as in weeks or months). Anything beyond that or in facilities or in some cases the luck of the draw of who else is in jail with you, creates more harm than good.
2
I think for many of us struggling with "addiction," there are deep multi-generational behavioral patterns that are difficult to understand and change. There is no one-size-fits-all approach to "addiction." As an interesting point of comparison, I see addiction patterns (to alcohol, tobacco, codependent relationships/behavior) in both my and my wife's families. However, these patterns do not manifest themselves in the same way. I would say on some level my family appears more dysfunctional financially (due to a lack of property ownership), but my wife's family appears more functional due to some substantive property ownership. I also see that my family tracks more to the anxiety/depression side of the road (with a history of suicidality) while hers tracks to the ADD/OCD side of the road (with a history of endless activity being a primary coping mechanism). There are also significant cultural differences between us. I will say that I do believe addicts whose families are less financially secure are in a hot mess, a mess that can lead into all types of "criminal" activity, especially in our current horror show corporate oligarch-dominated economy.
12
Someone's not doing their job if a drug court defendant is relapsing. The main idea of our specialty court model is to bring together a group of professionals and clinicians, draft a treatment plan, and provide oversight and general maintenance in hopes of sobering up a defendant, thus avoiding a short- or long-term jail time. Unlike the regular docket, where the only ones standing before a judge are a defendant, defense attorney, and prosecutor, the drug court all too frequently fails to achieve its intended results. When this happens everyone loses - especially society as a whole.
Rearranging letters to spell disease instead of addiction is simply a waste of precious time and scarce resources. Time & resources which could be spent on combating the illegal flow of opiods from both the black market and unscrupulous medical doctors.
No doubt governments allocate more money to disease prevention and control than they would to an outbreak of drug addiction. But that doesn't lessen the end result.
Frankly, returning a chronic drug user to his/her state of nature is more of a problem to overcome than playing semantics with legal and medical terms. Think about relocation over reentry. In the meantime, ask yourself this: Why is it those serving jail time for drug-related offenses sober up in jail? Could it be because they're removed from their originial drug-infested environment?
If you're serious about helping these people, move them to a more conducive . . . .
1
I’m a therapist currently writing a rock musical about heroin, a intimate look at the relationships between the addicted person and family, friends, and the drug itself. In one song, “Stigma”, I’ve written (and germane to this editorial) :
No other disease on earth can you find,
Patients labeled as criminals and justified.
No other disease on earth can you find,
Punished for having the symptoms the diagnosis identifies!
For years when working for a residential treatment program our agency struggled with how to handle relapses. At the beginning of my tenure clients were discharged and the time for reapplication varied over the years from one week to 90 days. As the heroin crisis became more severe, and when I took the clinical helm, we stopped discharging people for relapsing. There is no easy solution, but punishing people when their brains are far from healed is ludicrous. I saw far too many previous clients OD and die who were discharged for exhibiting the symptoms of their disease.
Now in private practice I would not certainly not terminate a relationship with a client because of a relapse. A higher level of care may be warranted, but not punishment, judgment and shame.
3
The "easy fix" for drug addiction is to "lock em up". Americans are quick to believe that what they don't see is fixed. The problems of addiction are complex; lock up doesn't work and doesn't solve the problem. We have a complex opioid crisis that cuts across all populations that won't go away with locking up anyone. Either we find solutions that deal with this problem or it gets worse. There is nothing easy or quick about the solutions but the criminal justice system is not a solution or a fix.
7
No one is being locked up for being an addict.
1
Considering addiciton to be a disease seems a slippery slope to me. If addiction alters the brain chemisty of "patients", lowering their inhibitions and their reasoning, are they then absolved of any other crimes they commit during their lapse of judgement? For example, can an addict who robbed a convenience store claim that his judgement was impaired and that he should not be prosecuted for the offence caused by his impacted brain chemistry?
9
Yes, what of the crimes committed while under the influence? Crack was a particularly dangerous drug because of the crime wave that accompanied it.
Drug use and addiction is a complex problem in our society and there is no path to sobriety that will work for everyone -- after all, each of us is unique. However, what is clear is that the use of the criminal justice system as a means of attempting to solve what is in essence the ultimate victimless crime punishes only the actual victim -- that person being the drug user him/herself. The Massachusetts Supreme Judicial Court has led the way in many areas -- most notably and recently, establishing the right to gay marriage -- and hopefully will do so again in the realm of our failed war on drugs.
6
Prosecuting drug offenses is job security for prosecutors. Private prison systems and police officers are often the target of anti-incarceration activists. But what about prosecutors' role?
20
The editorial underscores the importance of treatment for substance abuse instead of prosecution (though if aggressive/unlawful behavior against others is committed too, this might certainly warrant an exception).
Calling substance abuse or addiction a mental disease is not necessary (except for insurance purposes) for it to warrant treatment. One can make a compelling argument that substance abuse is a learned maladaptive habit (just like overeating to manage feelings and needs).
9
Exactly. Addiction is a symptom, not a disease.
3
Issues regarding substance abuse have deep and wide roots.
We live in a country based upon freedom- freedom that creates the negative space of personal responsibility. People can become addicted, and do to many toxic habits. Although this can be manifest by chemical changes in the brain, the problem is whose responsibility is the deficiency? Traditionally it has been entirely on the individual [family]. Now the balance is shifting more to a broader social effort to deal with the problem. Making this more of a public issue then addresses the six hundred pound gorilla of resources to address individual relapse.
I know people who you could never spend enough money on to get help- they simply have no motivation to address the problem. I the meantime we do need to keep them from driver seats, child care, theft opportunities or critical decision making.
4
"the negative space of personal responsibility" Very interesting term. Unfortunately, it's in this very space that addiction is successfully addressed. In the end, it's a monumental personal struggle that has to be fought. Perhaps one of life's hardest.
1
It becomes society's responsibility when you begin criminalizing the use of "Drugs" by an individual behind their closed doors.
Criminalize theft ... criminalize child abuse ... criminalize driving intoxicated ... etc.
Criminalizing drug use is akin to criminalizing homosexuality ... adultery ... masterbation ... dishonesty.
Dishonesty is wrong, but it's not a crime until it's crossed into the territory of theft or fraud.
We need to draw similar lines for drugs and I don't think dressing the religion up in "medicine" is really serving to help bring us towards the sort of progress that will really free our society from the most serious ills of our social disease (gang violence, war, widespread death).
1
I'm 64. I've every sympathy for addicts and wholly agree our criminal approach is misguided. But to my generation, "disease" meant an objective physical issue; e.g., bacteria, a virus, a cancer, a missing enzyme, protein, reaction, etc. Addiction was/is an affliction; though no less blameless than a disease.
"Will power" is not a dirty word, either.
9
This framework was once the understanding. This idea was that "will power" was lacking in individuals who had addictive behavior. Go to an open AA meeting or act as a guest on the online meetings of Smart Recovery and listen to the inspirational efforts people are making to overcome addiction. You will be humbled by their courage.
8
Kuhlsue: That is Paul's point, I believe. That it requires something deep within the addict to manage addiction. This was once known as "willpower", the power of one's will to overcome great adversity. They are certainly heroic in my book.
AA and Smart Recovery meetings can be very useful (when attended and "worked") to prevent relapse. Smart Recovery is a cognitive-behavioral approach to treatment that helps people recognize triggers for substance abuse and how they can learn skills to avoid using again. It is highly consistent with viewing addiction as a breakable learned maladaptive habit. People in this regard are not viewed as powerless.
"Believing" whether addiction is a disease is analogous to "believing" there is no climate change. In both cases the science is the there. One responder felt that drug addicts should be denied "expensive cures". I have major depressive disorder which is caused by altered brain chemistry. No one can see that. All people see is my behavior which is a function of the malfunctioning of the brain chemistry. As a result I have been very suicidal. Should I be denied the "expensive treatment" (major depression is not curable) because I tried to commit suicide? I did that to myself just as the addict causes a relapse by their own behavior. I am not incarcerated, but forced to be admitted to a behavioral health unit. Why shouldn't addicts get the same treatment attention?
6
Our society has long leaned toward the judgmental and punitive when it comes to addiction. The cultural belief that Americans are tough, rugged, and hard working leads many to judge addiction (indeed, all mental illness) as weakness, character flaw, and/or laziness - all cardinal sins in the toughness model.
When I ran a church-based social service center in downtown Chicago about 20 years ago, one of the frustrations was the lack of rehab beds even for alcoholics - unless one had excellent insurance or personal wealth. Homeless folks could get a detox bed for up to 10 days, but when they were dried out there was a very long wait for any chance at the scant help available. Most simply went back to drinking.
It is certainly time we stopped throwing people away or paid exorbitant costs to keep them in jail/prison. It is not even penny wise and pound foolish - it is simply foolish - stupid really.
86
Good point about our societal malfunction when it comes to all mental illness. About 1/2 of all those in jails and prisons suffer from some form of mental illness.
3
It seems to me that the key element in the disease concept is that most addicts (drug, cigarettes, alcohol) acquire the addiction early in life as teens or pre-teens. The use is a temporary relief from emotional pain that is already felt by the young person, or the entry into the adult world observed by that person in his family or surroundings. I think it's fairly obvious that there is this and maybe some other very simple rewards that are attached to addiction and its consequences to addicts over time. If the majority of addictive behaviors take hold early in life, the resulting depth of destruction makes perfect sense. Young persons brains don't fully form in the rational abilities of adulthood until the age of 24 or so. By that time many alcoholics and other drug addicts have had chronic or serious issues with family, school or other social behaviors that affect lives and futures. Rationality and punishment are not the cure that resolves the addicts dilemma. There are treatments that work. They need to be sought out and enhanced in their ability to do the job.
30
You can't "acquire" opioid or alcohol addiction. No matter how many opioids you use or alcohol you drink, unless an underlying genetic predisposition to developing addiction to those substances, you won't become an addict.
Cigarettes seem to be in a different category whereby pretty much anyone who used them on a regular basis ended up becoming addicted to them. Of course, we don't throw cigarette smokers in jail although it's worth noting that they did injury to hundreds of thousands of non-smokers who had to breathe in the toxic fumes from their cigarettes.
3
Yes,
I support legalization of drugs, but also harsh punishment for those that give or sell drugs to anyone too young to join the military. (I would make that agree 21, by the way. Adults should be asked to serve their country, not the young and naive.)
Most people become addicts as teens. If drugs were legal for adults, there wouldn't be a huge black market just for teens, because most teens don't have the cash to support that.
It is the complete criminalization at all ages that makes it easier, not harder, for teens to get drugs.
Ask a local teen how hard it would be to get drugs. Then ask them how hard it is to buy cigarettes or alcohol.
It's easier to get drugs.
1
A lot, probably most, opioid addiction begins when people are in their their 30s, 40s, 50s, and even older. They're prescribed for people in pain, usually from an injury or surgery, and a certain percentage of the people taking them become addicted. It happened to my cousin after he suffered a serious on-the-job injury. He became addicted to the medication and when he was cut off--the doctors recognized he was addicted, so cut him off but provided no support for dealing with the addiction--he turned to street drugs. He's dead now.
1
I'm dismayed by many of the comments. They reflect a simplistic desire to punish rather than a realistic assessment of how to fix a problem.
The article says that those braking the law should not be absolved of all legal consequences, but that the consequences should be fair and reasoned and calculated to reduce recidivism.
It's clear that addiction (however derived) is accompanied by neural changes - a physical issue susceptible to medical treatment. Incarceration without access to meaningful treatment is counterproductive, expensive, and inhumane.
Marcus Aurelius wrote that he did not regard himself superior to another because the other's weaknesses were different from his own. Each of us has weaknesses and vices, we just vary in the particulars.
111
Thanks Jim. I get dismayed too, but we as a set of human beings can resort to simplistic thinking, easily. I feel like you do that we are messy and imperfect. Were it not better to send that message along with we are wonderful in that we can change.
18
The problem is that managing addiction requires something on the addict's part. It is not something that can come entirely from society, medicine, etc. Empathy is lovely but it doesn't cure addiction. The addict must actually change his/her behavior. It must be a joint effort.
16
I bet you didn't feel that way about black crack addicts.
I'm not sure I agree that addiction is a "disease." Calling it that removes responsibility from the individual. And, in a way, it also removes the power to stop. I heard a big pharma ad last week claiming that overeating, also, was a disease and "not your fault." Or how about people with poor manners (on their phone during conversations or interrupting others) who apologize and say, "sorry, I have Adult ADD." Time for people to take ownership for their behavior, and for the medical community to stop providing excuses (and expensive cures.)
49
There is a mountain of evidence that addition alters brain chemistry forever. (Check out the National Library of Medicine website.)
But we treat all kinds of illness that are choice-based without the stigma. Do we blame coal miners with mesothelioma? Do we tell diabetics, "What do you expect, eating the way you do?" Do we tell people in their 20's with melanoma, "You went to tanning salons. Cope with the consequences on your own."
I've never tried drugs and a glass of wine puts me to sleep. I've never understood why you'd spend hard-earned money on cigarettes and literally light them on fire! Personally, I do think there is a degree of weakness of character to use a crutch -- booze, drugs, cigarettes, whatever - to get through your day but I've had a pretty easy life. Frankly, for years I over-ate and cookies were my drug of choice. That lead to a cancer largely caused by my previously sedentary lifestyle. No one at the cancer hospital scolded me but they did tell me to keep exercising and eating better.
I'm uncomfortable with the noncompliance and relapse patterns of addicts but folks with diabetes and heart disease are also expensive patients when they refuse treatment or relapse.
Also, are you really comparing poor manners with brain injury? Come on. You know better.
35
By your logic, HIV contracted by sharing used needles, Hep C contracted the same way, or cirrhosis of the liver from alcohol consumption are not diseases. By "...the medical community to stop providing excuses (and expensive cures)" do you mean these people should be denied medical intervention because contracting these "conditions" was the patients' responsibility? Seriously?
13
"I'm not sure addiction is a disease..."
Are you an addictions specialist? A therapist or counselor? Brain science researcher? A physician, at least?
If not, full stop. please put down your pencil. Public health policy should not be decided on the basis of personal opinion.
6
Is addiction a disease? If so, where is the scientific research to identify both the root-cause and from that develop effective treatments. Simply calling addiction a disease isn’t enough. The saddest part is that the only touted treatment is a self-improvement plan that basically says that addiction is a moral-failure and the cure is to make yourself a better person.
If addiction is a disease there has to be a bio-chemical cause that would explain why only about 10% of the population gets addicted while a much larger portion of the population uses intoxicants on a regular basis but do not become addicted.
Why do we incarcerate relapses? Because we believe the moral-failure argument and gave-you-a-chance and you did not fix yourself so the state will fix-you through incarceration. Americans don’t have a track record of toleration of moral-failures in your behavior.
As to my moral-failures: that is none of your business. Yeah, that is how Americans are.
9
Consider viewing this webinar to learn more about the scientific research about addiction root-causes and treatments:
https://www.youtube.com/watch?v=Rlb7cjHyJS4
1
Search "Volkow and Koob" and read the evidence. Dr's Nora Volkow and George Koob, having excellent research credentials in their own right, are the Directors of NIDA and the NIAAA respectively. Together they have been publishing excellent reviews of the research evidence for your edification.
1
George, there is much data to support the disease concept. Just dig a bit and you will find explanations that link addictive DNA (genetics) to the addict. Without going into a lecture about mid brain functions and dopamine spikes, try and accept that while the addict is in active use and for months into sobriety, the battle against cravings is debilitating until the brain chemistry returns to some semblance of "level." To expand a well know phrase... for one with addictive genetics, "substance" is "cunning, baffling, and powerful." (pg. 59)
To answer the question posed in the title of the piece, because there is a continuum between bad behaviour and behaviour that is due to an illness. And an overlap.
5
Big pharma--aided by willing doctors and the Trump Admin and Republican enablers--is succeeding as America's ultimate drug pushers.
"The pain hustlers"
https://www.nytimes.com/interactive/2018/05/02/magazine/money-issue-insy...?
"Big pharma gets a big win from Trump"
https://www.theatlantic.com/politics/archive/2018/05/big-pharma-gets-a-b...
"We're all addicts here"
https://www.nytimes.com/2018/05/28/opinion/opioid-addiction-tennessee.html?
25
It has been hailed as an important step in dealing with opiate addiction to stop treating it as a strictly criminal matter and start thinking it as a disease. But this has had some unintended consequences. Addicts interviewed on news programs now routinely talk about their addictions as something that just happened to them like catching the flu. They talk about becoming an addict because of one prescription from their physician. This is a false picture. Addiction requires deliberate and repeated use of the drugs in question for a period of time, and it involves an increase of dosage beyond therapeutic levels. Thousands of patients successfully use opioids in conjunction with surgery and traumatic injuries, and taper off and cease the use of opioids. Perhaps there has been too much removal of the notion of culpability in addiction and addicts do need to be penalized for the deliberate component involved in relapsing.
34
I have been to thousands of AA meetings over the years. This is what I have learned about the recent addiction crisis. People from all walks of life, who have had no prior experience with addiction, are suddenly becoming addicted after taking prescribed medications. This could be you some day or anyone. I takes time to become an alcoholic and it takes time to die of alcoholism. But these drugs can take a person down in one day. Look at your loved ones today and think about this could happen to any of them.
15
NO IT DOES NOT REQUIRE DELIBERATE REPEATED USE.
Sorry for the caps, Peter, but you are wrong about facts. The problem with opioids is that therapeutic dosages are close to fatal ones, not that people increase way above them. People can become addicted very quickly. Not everyone. Just like any disease, some are more vulnerable. Not more culpable.
In fact, most people stop using opioids themselves. Because diseases aren't always permanent. That has zero to do with punishment and "notions of culpability."
Stop using news program interviews as you guide. Read the science, and talk to people. Nearly everyone in America is within 2 degrees of an addict.
7
The problem with thinking like yours is that is completely ignores the scientific discoveries in the last 20 years that prove that the brain is actually physically and metabolically altered by ingestion of certain substances. It happens progressively and after a short course of the administration of the particular substance. Then it is, as the article stated, the exercise of the power of will over a very very strong craving, indeed, need. If it was "merely" utilizing one's innate will power, doesn't it make sense that few people would be addicts? Do you believe anyone WANTS to be an addict? There has been a lot of research on why people of the American Indian was so much more susceptible to alcoholism than the European whites that conquered them. The result? Different brain structure and function. That is the plausible answer to why some people become addicted and others do not. But at any rate, it is not the addict's "fault."
8
The issue is NOT decriminalization of drugs, so much as implementing treatment programs for addicts instead of warehousing them in jail. Addiction is a disease not criminally deviant behavior requiring incarceration. There are documented (clinically validated) effective treatment programs. It's a matter of providing and funding them, for those in need regardless of their location—in jail or not.
What makes the opioid abuse issue particularly egregious is that the drug is dispensed "legally" (as is alcohol, cigarettes…) and its addictive nature is known. Yet, rather than approaching the issue as a medical/public health issue it's presented as an issue of public safety.
Society has the means, it just lacks the will.
90
Although I agree with the sentiment of this article and your comment, I am very concerned about addiction leading to crime when supplies dry up and prices spike-
3
Go down to your local misdemeanor court. Sit in on a few sentencings. See how many times the judge either highly recommends or directly orders drug treatment.
Then talk to the judge and see how many people actually follow through with it.
Then sit down and figure out how to get another human being, with free will and a mind of their own, to actually go to treatment on their own accord.
People don't like to help themselves for various reasons, and it is very difficult in our society to force them to get that help.
4
Every addict should have access to effective addiction treatment.
Once.
If they relapse then it is on them. Society does not have infinite resources to waste on those who refuse to try to help themselves.
2
"With the help of her lawyer, she was diverted into a treatment program, and is now in remission and rebuilding her life." So it seems that having her drug test violate her probation actually turned out to be *good* for her.
11
Yes, what if the criminal prosecution is the only thing forcing someone into treatment? Without it, we know that many addicts won't seek help. A police officer I know described how one addict had been given Narcan 5 separate times. After each time, the addict refused to go to the emergency room. The police officer could not force him to go.
3
This article raises great points. Decriminalization of drug use would save many lives and lots of money. However, it fails to address issues concerning the need to vastly improve guidelines regarding substance abuse treatment. Chronic relapse equals ineffective methodology. We shouldn't waist money and precious time with totally ineffective methods any more than uselessly sending addicts around and around, again and again, in and out of the revolving doors of jails and prisons.
18
What about personal responsibility?
You have to choose to use illegal drugs and sell them.
The drug users that broke into my former building several times victimized all of us all there by their actions.
I just don't feel any sympathy for them, they had a long criminal history, the only time they weren't committing crimes is when they were in jail.
47
You should read the article again. Selling drugs and breaking and entering are crimes, nobody is suggesting otherwise. The idea is to focus on treatment, not punishment in dealing w/ addictive behaviors.
37
Just out of curiosity: how do you know, for a fact, that the people who broke into your building were "drug users"? Did the police contact you after the break-in to inform you of this? Did you attend the arraignment or trials of these individuals where this "fact" might have been introduced? While I sympathize that you were broken into, might I suggest that you are falling back on an easy explanation & a convenient scapegoat. It is easier to conflate two forms of "anti-social" behavior, to demonize the addict and throw away the key, than it is to even consider that in many cases, prison may not be the answer.
For further reading on the war on drugs I suggest Johann Hari's excellent book "Chasing the Scream". And yes, Portugal has had excellent results from their program to decriminalization drugs - even opiates.
For many drug addicts their only crime is the possession and use of illegal drugs. Please do not defile the thousands of people struggling with drug addiction by conflating them with drug users who have committed other crimes.
Also, personal responsibility is one thing, but why as a country do we have to mandate that some drugs are legal while others are not? Who does it help to lock someone up for using opioids? It doesn't help those struggling with addiction or their families, it only helps the prison industrial complex who are paid by the inmate.
13
I grew up with an alcoholic mother who decided she would never get sober. Another family member is now in sober living after three months of rehab for heroin addiction. Addicts and alcoholics have to want to get sober and want to stay sober to succeed. Throwing them in jail may be a safe alternative to having them die on the streets of an overdose. There is no perfect solution for this problem. Each state must struggle to find its' own solutions during this national epidemic of drug abuse.
31
I'm sorry about your mother. You are absolutely correct that she needed a "safe" place to live. Jail is NOT safe. It is designed by those currently in charge NOT to be safe. We need alternatives ---be they be large or small facilities for people who are unable to live and keep themselves and their families safe while they are addicted to whatever their drug of choice is.
22
@Juliana James
So you'd rather spend $30,000/year than $6,000/year. The best solution for stopping drug addiction should be adopted by all states. Why should each state stuggle to find its own solution? People aren't different from state to state.
10
As scsmits replies jail is certainly no safe alternative, did you not read in the article where it talks about the girl's suicide while awaiting sentencing?
7
There is much disagreement and discussion on whether or not addiction is a brain disease.
16
There is certainly no scientific disagreement or discussion about whether or not addiction alters the brain.
The discussion is only about whether what makes certain people to become addicted or not, could be CAUSED by the brain itself or not.
We all have self-regulating centers in the brain (the frontal lobes, for instance, which in human beings are much bigger than in other mammals, including chimpansees).
And we know that certain practices increase those self-regulating centers. If everything goes well, those practices are acquired by primary caregivers at a child's birth, and then, through thousands of small acts during the day, taught to the growing child, in such a way that as an adult, you know how to sooth and comfort yourself when overwhelmed with negative emotions, rather than having to look for external sources of comfort ("comfort food" such as chocolats, alcohol, drugs, peer approval, ...).
And these practices also lower your default stress reactions, AND increase the frontal lobes.
In absence of those practices, however, the frontal lobes don't develop, and self-regulation becomes impossible. That's when only substances (which unfortunately create addictions and very bad health, and often also criminal behavior, over time) can still regulate emotions.
So yes, it is a brain condition, but that means that the "cure" here is teaching those self-regulation skills, certainly not imprisonment (= putting you together with other people lacking those skills)...
12
Disagreement by whom? Although there are environmental factors involved in the development of addiction as is true of diabetes, cardiac disease, and many forms of cancer, a major part of it is considered to be a brain disease with genetic factors playing a significant part.
I challenge you to find a single study or statement from any recognized medical authority on addiction who disputes this.
11
Please read the article closely. All the relevant medical groups have concluded it's a brain disease.
This is no more a question of morality than getting cancer.
12
Throwing addicts in prison without any medical treatment should be a criminal offense punishable by imprisonment.
How many addicts die of detox convulsions in jails and prisons? How many, not being able to handle the detox, self harm or commit suicide? I imagine they are not numbers our prison system wants us to know.
Putting non-violent drug addicts in prison rather than in treatment is cruel and unusual punishment. Here's hoping the Massachusetts Supreme Court gives addicts a real chance at recovery. Our politicians seem woefully incapable of doing what's right.
73
My daughter, a heroin addict, had two felony convictions for drug use, and was jailed multiple times. In one way it was a relief when she was in jail, because she was safe from further drug use. However, every time she went behind bars, she went through severe withdrawal, and the only "help" the jail was allowed to give was Tylenol. It was agonizing. 4 months after release from her longest incarceration of 6 months, she died of an overdose. She was 25.
Our justice system is a huge failure. How does the cost of repeated incarceration stack up against effective drug treatment programs? Residential rehab is only available for those with very deep pockets. While all of society bears the cost of incarceration for drug addicts, only the rich seem to qualify for any help to escape the quicksand of addiction.
14
Exactly right, As for the politicians, there are those think being tough on or cruel to vulnerable people makes them look macho. Sad!
8
Thank you, Anne, for your thought filled reply. I am so very sorry for your unfathomable loss.
The U.S. prison industrial complex isn't concerned with such distinctions.
56
It's not tasked with making those distinctions.
Never was. Never should be. Those are matters of judicial concern.
4
Who makes the decision to not offer MAT?
Addiction is not a disease in the traditional sense of the word, controversial as that statement may seem. The first time that I had this clarified to me, it was by the director of an inpatient rehab, and it was years before most people had come to see addiction as less than criminal.
Having known that quitting (whatever the substance may be) has everything to do with the individual’s will to be free of chemical bondage made all the difference for me, but there are no two identical brain chemistries. Many addicts either need some form of cognitive behavioral therapy or group counseling in order to maintain their abstinence from drug use, and anyone who has experienced what it means to be physically dependent on an inanimate chemical substance can understand this much.
The larger societal implications of addiction can either be addressed through education and harm reduction policies, or the ‘standard model’ of programming children with “Drug Abuse Resistance Education,” which is an incredibly nihilistic approach to the school-to-prison pipeline.
26
This is a semantic argument. Addiction is a physical state in which the neurotransmitter balance in the brain is altered and in which neurotransmitter receptors respond abnormally. Some of these changes are very long-lasting and may in fact be irreversible in some cases (cocaine, for instance). In many cases we understand the molecular basis in great detail.
So, on that pure molecular basis, addiction is not that different from diabetes, for example, which also is an endocrine imbalance which feeds back onto feeding behavior.
Moreover, by your definition any psychiatric condition would not be a disease. Schizophrenia, depression, none would qualify by your definition.
If we need to change the definition of what constitutes a disease, that's fine, it won't change anything in the real world, only the verbiage, but the facts remain the same: Someone who is addicted suffers greatly when they cannot satisfy their cravings. Whether that is food, alcohol, drugs, doesn't matter.
It's the SUFFERING that makes this a disease.
17
Addiction in its many forms is a chronic disease and should be treated as such. When one lives with a chronic disease it is the responsibility of the patient to participate in life and continually seek elusive health.
I think what your director of the rehabilitation facility meant was that it is not always an acute disease. It is however chronic and relapse is an acute phase.
7
If the very nature of addiction is a matter of semantics, then surely life itself is also a disease which must urgently be cured.
Err, that can’t be right. That’s the very rationale which leads people to view the human condition as something which is wholly intolerable. Life without suffering is numbness.
I don't know if it is a disease or not. What I do know is we have to find a better way.
49
I find it odd that the editorial makes no mention of drug courts, which are proving to be a successful alternative model to the regular criminal justice system for those guilty of drug addiction related "crimes". See, e.g., Trey Anastasio, lead singer of Phish. https://www.jambase.com/article/trey-anastasio-speaks-drug-court-graduat...
As a kid(14)
I was arrested because a kid I was with(age15) had $5 in pot in a shirtpocket. I was charged firt with "possession in concert", a little known law that lets a cop charge a nother or a stranger lighting his cigarette, with common possession, even "criminal sale " of a controlled substance-a felony even though the vvictim charged never knew the possessor.
The father of the boy carrying the pot-a 1/7th of a ounce: A nickel, $5 worth of marijuana. thatI didn't even smoke!
The charge was changed to "sale with the intent to distribute a controlled substance" a felony!!!--So, they claimed, in -10 degree cold, with my associate-we travelled from east 96th&Lex. to 103rd st and CPW, just so I could then sell him $5 in marijuana! Instead of selling it to him at home , over on the upper east side.
The case fell apart of its weight, finally, but this is how the system works-terrify or just bulldoze the people and parents of ignorant people in the dock and they'll fold-"copping"-(accepting a guilty plea) .
To blackmail an innocent to accept a guilty plea to a non crime they may've had nothing to do with is the entire purpose and aim of the system of prosecution. If, in fact cops and prosecutors had to tell the truth and only prosecute actual crimes, the entire edicface of criminal prosecution,all of its judges, 95%police and especially the immense prisons and huge parole and probation departments, would collapse. THis is what courts and cops-even defense lawyers fear.
40
@meloop: Thanks for your evidence. This is why I believe the proportion of people in prison or jail who are innocent is vastly more than an Innocence Project can ever verify. I guess it's a minimum of 25%. I know this will draw hate mail, but I challenge anyone to produce good evidence one way or the other. Note to "justice system" worshippers: "But they were convicted/confessed" doesn't answer. You have to deal with the evidence of meloop and several recent Times articles that many convictions are based on intimidating people who have no resources.
6
As long as DAs judges will be elected justice will fall into demagoguery.
There is no perfect judicial system. And many who blame the some countries for having a judicial system controlled by the state have a point. But at least these judges and DAs are not subjected to reelection and sentence people so as to please voters.
I know I'm pushing the case a bit too far as many judges are honest, humane and reliable… then again the system must be overhauled or the judicial system will keep creating loopholes as this one and will keep feeding prisons with more and more inmates in this country…
3
Black people are doing serious time for less and have for a long time. It's only now that other people are caught in the net that there is this sudden outrage.
1
Ms. Eldred's case is beside the point when it comes to whether "relapsing" is a crime. It doesn't matter--it was a parole violation. Parole is a privilege; many things that aren't crimes are parole violations.
But truly, this model of relapse, as if it is a thing that falls out of the sky and lands you, is infatilizing. Most people are in control of their limbs. They choose to put on their shoes and they choose to go buy drugs, and then they choose to use them. The authors trying to parse the disease model versus free will, mainly by bending over backward to redefine will, is like Leibniz trying to parse the problem of evil. The result is intellectually unsatisfying, insulting to all involved, and invites satire.
I am in favor of a treatment model, largely because the current model does not work. (In the same way that I am open to rehabilitative prison models, even though I believe that most people who commit crimes do so of their own free will, because clearly our prison system does not work.) But all this hand-wringing about choice and the lack thereof is insulting. It's insulting to the people who keep using who are reduced to children who can barely control themselves, it's insulting to the people who choose to get clean, and it's insulting to the people who for many reasons choose not to start. We can get down to brass tacks about what works and what doesn't without constructing such an insulting and paternalistic moral framework to make ourselves feel better.
13
I'd say same much the same to Polly as to "Ma". There is no hand-wringing; there is serious discussion of effectiveness and how prison is worse than ineffective in dealing with addiction (see the article). Polly ignores that. Then, there is the well-known (read the Times) arbitrariness and abusiveness of the parole system, where minor violations of useless rules put people back in jail and destroy any effort they are making to rehabilitate themselves.
5
While Polly makes, in my view, a valid point about parole violations, she ignores the current science, as noted within the article and elsewhere, which clearly shows that addiction changes brain chemistry. Willpower doesn't change that. Willpower helps, but it's akin to willing oneself to get over pneumonia.
7
This woman didn't go to jail the first time due to drug addiction. She committed larceny (no details here, not part of the agenda?). Addicts need help, far beyond just professionals; they need each other. AA is the most successful program out there, and it's free multiple times a day, everywhere. HOWEVER, the reason the rationale exists in the first place is that when an addict keeps using, they are more than likely to commit crimes again - need money for drugs. Maybe they should be given access to the drug in controlled environments (methadone). Depends on the drug. But don't tell me that this policy should go - revise, add care and mandatory meetings, but don't eliminate. Pretty soon we'll be told to leave our doors and cars unlocked so that those that are poor and addicted have access to money and stuff for their drugs? It is somehow everyone else's fault. Have a heart - help but hold responsible.
14
Something is wrong with "Ma"'s thinking. First, what is "this policy"? There are many policies. Then, is "Ma" saying that prison is an effective addiction-control method? Finally, any comment that says things like "Pretty soon we'll be ..." is not a serious thought.
5
AA often won't allow drug abusers to discuss drug problems except as they relate to alcoholism. AA itself cannot be proven to be the most successful program out there because it is anonymous. Where are the stats?
1
I am not sure of the current term of the day to describe my place in the ladder of drug addiction. I am "in recovery" or "recovered" or a"clean addict"...The popular term of art is really not important to me...The fact that I have not used an opioid (heroin, oxy, pervs etc.) in over six(6)years is what is important to me...The fact that for ten(10) years I was stalled in a period of non-growth that cost me my profession, my love-ones, my integrity and my honor. I have slowly been able to recoup some of these losses. My love-ones being the most important, followed closely by integrity and honor.
It is important to note that in my period of insanity , I was a "junkie" , a "Fein", a reprobate"...and these were the most polite expressions of the community. Now, I would be a victim of the proliferation of the opioid epidemic. Society would find me worthy of their sympathy and support. This was always the case for those "in the rooms"...you know who you are...The law enforcement community, criminal justice community and the general community are just catching up. However, there are those "dead-enders" who still believe that addiction is a matter of will-power and character. Gob bless them. Their recovery will come or not !!. Regardless, do not let them hinder, thwart, prevent or halt in anyway your fight to get clean. Relapse is part of the process . Use it to move forward. God has blessed the recovering addict, because in them will always be the real "truth" of who they are...!!
11
As Ayn Rand said in Atlas Shrugged, if your conclusion doesn't seem to make sense, examine your premise.
7
I'm no fan of Ayn Rand's but it appears that many of her self-declared followers don't understand much of what she wrote.
3
To me conclusions make sense here …
As for Ay Rand I never understood here conclusions nor her premisses (except of course these pre-101 pseudo-philosophy phrases like this one)