Shame on you for tacitly equating diabetes with drug addiction. While some forms of diabetes are lifestyle driven, Type 1 diabetes is a chronic autoimmune disease for which there is no cure requiring people with it to go to Herculean efforts daily to keep alive. People with it do not cause it with their diet, exercise, or lifestyle choices - in fact, throwing them in a room with lettuce and without life sustaining meds will kill them. Your reporter and editors need some serious education about diabetes and to stop perpetuating stereotypes that damage individuals fighting for their lives every minute of every day.
3
A more general problem is that most treatment programs, voluntary or involuntary, are woefully outdated, relying on the faith-based, 12-step model. While the authors write of “empowering people to take control of their lives,” Step 1 in AA/NA is for people with addiction to admit that they are powerLESS. Incarceration as treatment is merely an extension of the negative, shut-up-and-do-as-you’re-told ideology that predominates in addiction treatment.
6
The problem isn't involuntary commitment; the problem is poverty, inadequate addiction treatment, and putting the burden on families to house and feed their addicted loved ones if they don't want to see them homeless and preyed upon in the streets.
Addicts can't think straight when they are high and drunk so they rarely hit that mythical "rock bottom" that takes them to a detox clinic. But when they get through detox and begin experiencing sobriety for the first time in a long time, they might actually want help staying sober. But it's the treatment model overall that fails them and fails families. By the time an addict is in rehab usually their entire life is in shambles: their relationships, their employment, their housing situation, etc. and rehabs rarely help with more than keeping them from accessing their drug of choice for a limited amount if time. The addicted are "processed" and when they relapse families and friends get traumatized all over again.
Right now, many rehabs are little more than a low-security jail and the therapy is "old school" pull yourself up by the bootstraps methodology. The staff lacks education, expertise, and training. It is a sad state of affairs, but hopefully if we can continue to spotlight the inadequacy of these treatment facilities we will see some improvement.
Addiction is excruciating. The real solution is solving poverty and disburdening families of having to provide safe housing--whether the addict chooses sobriety or not.
17
@Cybil M The children of the rich can become addicts too. Not that uncommon.
3
@Nightwood Yes, anyone can get addicted but outcomes are worse when you are warehoused like an inmate and given little by way of therapy and then tossed back into a situation of homelessness and poverty.
4
"Imagine your aunt has developed diabetes and you want her to get better. Medical science suggests that medicine might help, but you decide that the better strategy is to lock your aunt in a room and force her to eat only lettuce — even though she hates vegetables. No medication, no discussion of other options."
I laughed when I read this. I actually HAD such an aunt - she would eat uncontrollably 11 months every year, but then go to a clinic in Switzerland on the 12th month, where she was probably fed only lettuce, but after 30 days came out thin as a sylph and diabetes-free, of course having paid vast sums for the privilege. The authors - lawyers, both of them - might usefully consult with some medics before writing any more nonsense, starting with their article's headline, which condescendingly assumes they telepathically know what readers think!
2
This is an absolute disgrace. Why should rich rehab patients get to live in malibu and ride horses while being free to go at anytime, while poor ones get thrown in a prison in all but name, under lock and key?
This kind of inequality will destroy our nation.
4
I don’t think much of your hyperbolic “diabetic aunt” analogy. Lettuce only? Really? Diabetes is a disease. Addiction is substance abuse. Don’t get the two things confused.
2
Sounds strangely like what is goin on in China with the Ughers.
1
To say that people who use street drugs are not committing a crime it is part of the problem. It’s is a crime to purchase street drugs and to be substance impaired in public. Society has to stop thinking of ‘recreational’ abuse of intoxicants as if it’s merely all good fun when in fact it isn’t.
1
Although we sometimes need to hold people against their will - be it for addiction, mental illness, illegally entering the country, or committing any other crime that requires detention, there is no reason we need to do so inhumanely and in conditions that virtually guarantee a poor outcome.
The one thing I don't see mentioned in this article and in the comments is the prevalence of privately owned detention facilities for these issues. I strongly suspect there is a great deal of political maneuvering to get all these downtrodden people into private holding centers in order to enrich these contractors and their buddy politicians.
Unfortunately, it seems that most of these contractors only care about their bottom line, not about people.
4
Forcing one to go "cold turkey" to detox can be very dangerous depending on what that person is addicted to. It can often be fatal and it most certainly is a very painful way to detox. We need a little more compassion in dealing with those who have become victims of the opioid crises. Locking them up without proper treatment and care is a very cruel and dangerous way to deal with addiction.
5
Have I read this article properly? How is it possible, as this report seems to state, that people are being locked up, denied their freedom to live their lives as they so choose, even if viewed as ultimately destructive, without having committed a criminal offense?
What used to happen is that people who appeared to be a clear and present danger to themselves or others but who had not committed a criminal offense could, by law, be incarcerated in an appropriately designated facility for a certain specified number of hours before they had to be released. But in the circumstances described here, it seems as if all that is necessary to deprive someone of his or her freedom is that someone else doesn’t like how that person is behaving. Is that enough? Is that the low bar we are now accepting in the face of the opioid crisis? What next? Desperate asylum seekers, lawfully seeking refuge as prescribed by both federal and international law being locked away in cages like animals, separated from their terrified children who are locked in other, sometimes distant cages? What have we become?
3
We don't really know WHAT to do, do we? Even then, what we do is usually done through crude law enforcement tools rather than therapy or rational intervention. Maybe we could divert $3.5 billion from the Wall to compassionate prevention, treatment, and intervention programs.
4
Apparently you don't want my opinion, so let's see if this slips by the NY Times censors. Keep these addicts locked up and give them all the drugs and booze they want. Forget the rehabilitation stuff.
4
@Ste
And you're OK with paying 60K a year forever to lock up millions of addicts? With money "stolen" from you (aka taxes)?
"You can't save someone who doesn't want to be saved". After dating an addict for several years, I now realise that unless the person wants to stop, there is no stopping them. Tough lough, mollycoddling, begging - it will not work. You can try to force someone to stop, and it just encourages them to hide it rather than quit.
Their dependency is often as mental as it is physical. Until they ask for help, it cannot really be provided.
4
A piece Terry Gross did on Fresh Air earlier this summer hosted someone who wrote about getting addicted as part of his medical treatment for an accident. They found there was no treatment plan for getting him off the meds they put him on, that there were alternative meds that were just as effective but withheld because of cost, and no one in the system to treat him at all until deemed an addict.
The truth is we don't have a system, any system at all for most Americans to find help. Then we blame them for not getting help.
5
My long experience with drug addicts and the study of the problem teaches me that, 1. heroin addiction is by any practical measure permanent &, 2. Junkies will always introduce innocent young non opiate users to hard dope ie they will get your kid killed.
Junkies are a serious danger to society. They are the equivalent of a person who has cut off their own right hand and is now desperately interested in cutting off yours. Good people who work hard and have no experience with the street drug users have completely inaccurate ideas of just how compelling and addictive heroin is. A heroin addict will do anything to get high, it's just a roll of the dice if on their way to accomplish that goal they do something that harms you or your loved ones including addicting your kids.
On the question of rehab at public expense; 1. there is no cure for heroin addiction, it's permanent, and addict can not use for 20 years and in the back of their minds the craving is there. 2. blowing public funds for treatment comes with opportunity cost, that money could be going to a proper good cause rather than a vacation for a junkie.
The bottom line is that the cycle of dealer/addict/innocent introduced to dope needs to be broken, not protected. Junkies should get "treatment" only in exchange for turning in their dealers, and that treatment should consist of prescription heroin not chat sessions. Anything else is a capitalist treatment trick, just like drug addiction is a capitalist nightmare.
2
This article offers a false choice. It would be possible to commit someone to involuntary treatment with a therapeutic environment rather than a jail.
1
Who would have guessed incarcerating those unfortunates who turn to drugs and alcohol as a means of escape wouldn't respond well to incarceration in a sterile environment that has little to offer but the company of other addicts likewise joansing for a fix; that is addicts who aren't wealthy enough to afford regular talk therapy and time out every so often at a private retreat when their cravings gain the upper hand.
1
Another failure of the corporate society.
What about the people who are killing themselves because of their addiction to cigarette smoking? What about alcoholics, especially those who don’t drive? Do we round them all up and lock them away for treatment? The rationale for locking up people who are addicted to illegal substances but not legal ones is patently absurd and ruinous.
7
Your kid is going to kill himself or herself with opiates, alcohol or some other drug. Though they have robbed you and lie when they open there mouth and have relapsed more times than you can count, yet you still love them and won't give up on them. Section 35 civil commitment allows you to get your loved one into treatment in a secure setting where they don't have to wrestle with the powerful incentive to leave treatment as they would in a voluntary treatment program. Your loved one's mind clears up enough over a couple of weeks so they can start to feel a little more normal and see a little more clearly the fatal threat of their substance use disorder. They are then transferred to a treatment facility (as happens in Hampden County) without a secure perimeter, in the nearby city for an intense 30 to 60 days participation in an addictions ciricculum and clinical therapy regimen that educates and motivates them about and towards recovery. They are hooked up with the recovering community and come to know that they are not alone or unique and that recovery is possible. They are released with resources in place that adress community based recovery programming, medication assisted treatment, mental health counseling, employment and housing.
Interview the clients, parents, friends, relatives, attorneys and judges about these two facilities and you might find that some have a different perspective than the author presents. A follow up article is necessary.
16
It is really critical that readers understand the differences between what this article describes in MA & community treatment courts. Here in New York State, ALL substance abuse treatment is voluntary by law. If you want to leave treatment, you always have the right to walk out the front door. People who get into rehabs here in NYS via treatment courts & the wide array of other legal sanctions certainly may have consequences if they leave treatment that is an alternative to incarceration, but no one tackles you on the way out the door. The court orders that get people treatment also in many cases mean the insurance company has to pay. Insurance companies don't want to pay for inpatient treatment & have done their best to gut these services nation-wide. So treatment courts have become a bulwark for addicts in need of treatment. As for success rates, prison alone has the lowest success; treatment alone is next; the structure of treatment courts - rehab usually followed by outpatient treatment & a year-long contract with the court requiring regular report-ins - has the best success rate of all. Unfortunately this article does not place the MA situation in this larger context.
2
I am an addict living in recovery with very long term abstinence
(over 49 years) The turning point for me to escape the abyss was acknowledging my addictions to myself and peers, surrendering and becoming teachable. I always have a choice to return to my addictions but, today, I have support groups, sponsors (mentors) and a cell phone to call others who are in the same situation as I am. I seek help and offer help too. Involuntary incarceration is not a treatment that will have a path to abstinence and recovery. Addicts will not be subjected to others good intentions to help them until they want to quit and seek help themselves.
Just don't enable the addict, offer love and, if it helps you, accept how hard it is to change oneself, how can we expect to change others? Especially, our loved ones.
2
Having been around recovery for the last 35 years I find your opinion to be a bit too black and white. Often when a person is mandated into a treatment facility it is not only to get them help but to have that "first touch" with some sort of social services. It is similar to the methadone and needle exchange concept. Once you have met them there is a opportunity to help them get clean, off the streets or just to repair their lives. Now, I totally agree with your view on treatment centers that are run like jails. There are some amazing facilities in this country that have help countless people but criminalizing addiction and profiting from it is not an answer.
8
All involuntary commitment accomplishes is peace of mind believing that your addicted love one is not using. Addiction is a disease. It can only be treated effectively when the addict is ready for whatever treatment s/he is willing to undergo. While an addict may embrace treatment while involuntarily committed, society would do far better, I believe, by making more programs that are ethically and humanely based available. Addicts do not act rationally and forcing them into situations where they have no choice will not make them act any more rationally. The hope that we have for those we love who are addicts is that they take the steps themselves to make themselves well. Supporting programs that are more conducive to providing these opportunities than involuntary commitment is where we should focus our efforts.
What flawed "reasoning" - even granting that "treatment center" is a euphemism too far - by far!
1) It is outlandish to compare diabetes patients in an SNL sketch-type scenario to people who are addicted. When the authors talk about the risks of deaths post-treatment as some/many relapse, they make no mention of the horrible costs - yes, fatal overdoses, first and foremost - of leaving people on the street.
Yes, voluntary treatment probably has "better outcomes" in general, but what DOES a society do when - of necessity - the people who need care the most are least likely to get it?!
2) Almost every society has something like "preventative detention," a not-great solution to the problem that some people if released from custody would do harm to others.
For example, we're right to consider the mayhem that might well ensue if/when drug dealers or terrorists are released into a democratic, mostly open society.
An addict has - almost by definition - lost the ability to find his or her way in a world that is brutal to those who cannot take care of themselves. Contemplate an overdose victim in wintry Boston! (Not grandma forced to eat lettuce ... for heaven's sake.)
This is clearly a case of the treatment centers being the lesser of 2 evils. There are compelling reasons why 38 states want this in their "toolbox" to treat one of our 2 or 3 biggest public health problems.
Last, society CAN and should consider the costs of a "kid gloves" approach. It's billions of dollars!
4
In my experience with the Massachusetts system it took three individual visits in court with my son to attempt to save his life. The point was to convey our urgency to him, that we were at a loss how to further help. We failed. The range of violence at home left us to societies safety valve, the police.
The key point here is that the most incorrigible need assistance too. Simple logic implies those incarcerated have demonstrated greater risks. At Ludlow they receive extensive opportunity to re-think their direction.
6
I appreciate the problems inherent in involuntary commitment for drug treatment, and agree with the author that it could be vastly improved. But I disagree that it should be abolished. Almost by definition, an addict is not capable of making rational decisions about his or her treatment. They may refuse to undergo voluntary treatment. It is not surprising that long term outcomes are better for those who seek voluntary treatment--they are the ones who are strongly motivated to get better. As the father of a son who suffered from mental illness, I know the agony of families who cannot convince a loved one that they need help. I still wonder if he would be alive today if he could have been convinced to seek inpatient treatment. If involuntary commitment is abolished, the families of many addicts would have no options to help their loved ones. Despite its problems, involuntary commitment at least offers them a small measure of hope.
7
What happens when an addict overdoses, requires emergency medical attention which includes a stay at a hospital, is "stabalized" and released, only to start the process all over again? At what point do the voluntary choices we make become both s danger to ourselves and to the community around us? Treatment centers need to be just that - staffed by experts with a commitment to the long haul that recovery requires. The very nature of addiction suggests an inability to make healthy decisions for one's self. At some point our choices prove the power of our addictions over us. It is cruel to allow people to make decisions which lead to ultimate self-destruction, especially when those decisions also destroy the people who love them and the community around them. Society has to be willing to pay the full price for recovery. The fact is we are paying the price one way or another.
6
While not an addiction treatment expert, it does not take an expert to understand the following statement, "Encouraging people to be active participants in their care and recovery improves the impact of treatment, while empowering people to take control of their lives. "
Each person's path away from destructive behaviors is an individual one. There are proven strategies that work, but not all people may respond the same. It may be easy to market "one size fits all", especially if you are the beneficiary of public tax dollars, but unless that "solution" provides an overwhelming majority of positive outcomes within the treated population, the problem will persist and cost more money than actually working to solve the problem. One thing proven multiple times is that incarceration does not provide a positive lasting outcome.
1
@Leithauser
Even if you're correct - and let's all admit that these arguments are only minimally "fact based" (starting with the authors of this piece) - one would have to say that there are at least "problems" and goals here:
a) enabling addicts to survive - ideally, "back at work." (Some of the same arguments about "treatment centers" remind me of anti-methadoners. Yes, if were your kid or mine, the COST of "talk therapy" would not phase me ... unless, of course, I had to pay for it!!)
b) freeing society from the costs - hospitals, police, citizens being robbed, etc. - IT incurs re addiction
Where the authors of this piece fail us - and maybe, they're just keeping their Hippocratic oath - is in limiting their "caring" to the addicts. It's not Trumpian to say that addicts are like hurricanes, destroying many lives other than their own.
The concept of "being possessed" is now mostly limited to fiction for most of us, but for all the "public health" lingo, that's what we're dealing with re addiction.
"LOOK THEM UP" ... SO THAT some, at least, will detox and NOT relapse sounds harsh, I admit, but the citizens of Mass. are not monsters. They are trying to save the lives of people who seem hell-bent on risking and taking their own lives!.
Yes, trying to curb the supply of opiates must be done, and the "treatment centers" SHOULD do more, but this approach makes every bit as much sense as "red flag" laws re guns. Out of control people should not be armed or "on the street."
While I don't dispute the info, a friend from college was well down the road to killing himself thru drug use when he was given the option of treatment or jail. He's been clean for decades now. For him, and certainly for some others, this approach saved his life.
7
It's bad enough that most rehab centers are based on outdated, non-reasearch based 12 step programs and are often staffed by unqualified staff, but now we will try to mascarade jail as "treatment"? How about fine the drug companies enough, not just a slap on the wrist, to pay for research and real treatment options. This looks like another way to feed the for-profit prison system.
6
Long-term recovery cannot be divorced from the crucible in which addiction began in the first place. Dysfunctional families, poverty and creeping economic hopelessness will still be there when the user is released from "treatment".
Building a network of support to maintain sobriety is never easy and will have some failures but hopefully more successes to bend the curve.
Continued treatment-jails as our solution is just an incarnation of the old chestnut: give a man a fish and he will eat for a day; teach a man to fish and he will eat forever.
5
@Douglas McNeill
You make excellent points here. We as a society must commit to building those support networks- and increase opportunities for re-entry into decent housing and employment.
1
@Douglas McNeill
My parents were both alcoholics, my father's addiction killed him, my mother sobered up with the help of AA. Both came from healthy and financially sound families. Both were well-educated professionals. I attended meetings with my mother and socialized with dozens of her fellow alcoholics, all lovely middle-class people -- with addictive personalities. Let's not put the entire blame on poverty or "creeping economic hopelessness." That's not going to help at all.
1
Previous post continued
Addiction tx is notoriously underfunded. Addicts are not sympathetic figures, so State and Federal legislators, despite periodic mouth service about the need to do something, do nothing. States do spend resources to lock addicts up, but they have no need to make special facilities to do so, criminal law and existing prisons are more than up to the task. That is one of the main reasons we have more citizens per capita behind bars than any other nation on the planet.
That some states do have functioning involuntary commitment facilities is actually good news. Individuals who have reached such a late stage in their addiction that their associated behaviors actually place themselves under immenent risk of harming themselves (which is what the law stipulates for any involuntary commitment), are statistically less likely suceed regardless of tx. So your argument that these facilities are ineffectual misses the point. They do what they are designed to do; address an immediate crisis in which the individual being locked up is unable to make a rational choice and they could very well be dead by morning.
Here is a real cause for you. Work on decriminalzing all drug use and diverting those resources currently dedicated to criminal incarceration to education, prevention, and treatment.
10
Just a question —
The article mentioned that those put through involuntary treatment were twice as likely to OD than those who went through voluntary treatment. I think that what really matters here is in fact the rate of ODs in people who had involuntarily treatment vs. people who had no treatment at all. Does that statistic exist?
It seems rather intuitive to me that those who volunteer for treatment would fare better than those who aren't motivated to seek treatment. If there was a statistically significant difference between the rate of involuntarily treated persons and those who received no treatment, I would say that there is a compelling argument to be made in favor of it.
(Not that I agree with the practice of involuntarily treatment. I just think that it's an interesting bit of possible information missing from this piece.)
12
I am a CDP in Wa state where we have a law that allows for a person who is demonstrably a danger to themselves or others to be held on the order of the county designated CDP(s), usually associated with that counties detox, for up to 72 hours. For more than 72 hours a judges order is needed. A number of years ago I was one of those county designated individuals. We have a very similar law for people in a MH crisis.
What this means in practice is that an individual is secured somewhere (in my county it is the local non-profit hospital) under the law for less than 8 hrs. Once they sober up enough so that they are no longer in danger of stumbling into traffic, or getting into disputes with treople (these are people who hide in trees and mess with meth addicts on a week long run), they are offered an opportunity to go to detox, and if they decline that, they are released.
Wa state used to have 2 facilities dedicated to court ordered longer duration tx. However, since it takes a lot of resources to build a case that someones addiction is so severe that they are unable to take care of themselves, these facilities were filled with voluntary commitments. The court order was merely a way to get funding expedited for poor people in an addiction crisis. The ACA eliminated that need, and both facilities have converted to standard tx.
I do not know what is going on in other states, but your argument rings false for a number of reasons which I will elaborate on in my next post.
7
Perhaps this is true for drug treatment. It is certainly true for jailing without drug treatment. Suboxone is an effective medium-term treatment method. With mental illness, I think there is a need to reopen some medium-term crisis centers and long-term hospitalization options. When Kennedy advocated for community treatment, it solved a problem but created another. I think we need more federal funding for addiction treatment, homelessness and mental illness. Dostoyevsky said how we treat our prisoners is the mark of our civilization.
6
Because drugs were essentially criminalised eighty years ago, there is an automatic association between drugs and crime even if a person only uses drugs. The assumed progress to other crime and self-harm derives from this association.
If a person has committed other crimes or has shown repeated recidivism then involuntary treatment may be appropriate; but only if the treatment regime is as much therapeutic as punitive.
Insofar as the matter has been properly studied, voluntary programs are far more successful long-term.
I would also note that people who have no drug problem, when sentenced to the prison-like environment depicted, often leave with a serious problem.
Food for thought!
5
Why don't we just accept that a certain percentage of our citizens can't cope with life as we know it in the United States and turn to alcohol and illegal drugs to kill the emotional pain of living? After all, millions Americans drink alcohol and use some of the illegal drugs socially or at home on weekends for the same pain-killing benefits. For some reason, they just don't get hooked. If we accept that some people will get hooked, the practical and humane response would be to keep them alive whether they can break their addiction or not. Food, shelter and safety at the bare minimum. To prevent them from committing crimes to support their addictions. we should supply and administer their drugs in safe doses at clinics. Psychological and spiritual counseling, drug therapy and other support should be available at these clinics for those who are ready and willing to get clean. Many never will be but they are still human beings. Life is hard.
10
@abigail49 Because self-medicating with opioids is probably a worse idea than medication and treatment by a psychiatrist. This is why we need universal health care, and vastly expanded mental health services.
But yes, we should have food, shelter and safety as a bare minimum in our society, for everyone, period.
2
@abigail49 Yeah, it's called methadone maintenance. Exists in all cities.
@abigail49
You should do some research on addiction. Many people become addicted to alcohol or drugs because they want the sensations. Not because they are in pain from poverty or any other outside influence. Many, also, support their addictions without breaking laws. Attend a meeting of Alcoholics Anonymous and listen to the speakers.
1
"Reams of evidence on the success of harm-reduction programs refute the idea that people who use drugs cannot make healthy or rational choices."
I can speak from my professional experience (MN LADC - working towards an LPCC) that clients seeking treatment in these kinds of harm-reduction settings are provided something that is often missing from traditional modes of care; an emphasis not on sobriety - but of improving their quality of life from their perspective. These may or may not be the same things.
Individuals with a substance use disorder may be best understood as individuals who are using substances to find relief from social, psychological or physical discomforts that they feel they have no better option for. This is often due to inadequate care in many dimensions - some obvious and some not. Individuals who have chronic pain from limited access to medical care are obviously at some risk for developing a dependence on pain medications, but individuals who grow up exposed to trauma are far more likely to be at risk for complex chemical/mental health problems.
What unites both of these hypothetical clients is a need for care that is highly individualized, integrated, and emphasises supporting them in addressing the problems that they feel they have, not the problems that others have with their choices. Isolating them from their world is a very invasive choice - made more so if it is involuntary - and should only be done in extreme situations.
9
Why is diabetes the chosen analogue. There are many psychiatric disorders and mental diseases for which a person can be involuntarily confined. Given that drug addiction can both adversely affect society, through elevated crime rates as people feed their addiction through whatever means necessary, as well as the person suffering from addiction, because they are essentially unable to take care of themselves, the much better comparison is schizophrenia.
I am behind not letting addiction become a scarlet letter. I support that the best way to deal with addiction is to get the addict the help that they need. I do not subscribe to the idea that society should allow itself to be subjected to the ills which addicts create. It would be great if addicts saw the light and checked themselves into treatment; many do and are better for it.. For those that don't see the light, leaving them on the streets to suffer and to bring suffering to others isn't the solution.
11
@Dave Most of those addicts were harmed by our society, to the point of needing ANY relief from its cruelty. That’s what it costs to sustain policies which exploit the many, in order to coddle the few.
Rates of addiction surged when we collapsed our economy and government. Coincidence? I think not. The health of our citizens CANNOT withstand our interminable wars, our costly and moralistic health care system, and the steady erosion of our middle-class. Addicts see reality for what it is. You’re the person who needs to wise up.
@J
Where are the studies that support the truth that "most addicts were harmed by our society?" Addiction to alcohol and drugs is seen at the highest levels of society and has been with us -- around the world -- in hard times and wonderful. Addiction has many faces -- people drug themselves because they like the highs. They do it because they can't handle life. They do it because ... of hundreds, thousands of reasons. They do not do it to "see reality."
1
As someone familiar with depression and with schizophrenia in family, friends, acquaintances and, for that matter, street people, I know that when people go off their meds or refuse ever to go on meds ("There's nothing wrong with me"), hell breaks loose.
As a longtime New Yorker, I also know that when Willowbrook and Creedmore closed and patients were given their "freedom" to live on the streets if they so chose, everyone suffered.
There is no freedom on the street for someone screaming in his own mental prison because he cannot or will not take meds.
And addicts who cannot get clean on their own, who are saved time and again from overdoses, and whose behavior affects their families and neighborhoods, might need to be forced.
1
seattle has 10k homeless, of which 200 died last year, partly due to addiction. The death rate is far higher than prisons or hospitals.
This article is an example of the kind of ‘progressive’ thinking that leaves people to die of addiction on the streets. This policy calls treatment cruel, and so chooses the more dangerous option of nontreatment. This policy talks as if is compassionate while leaving a trail of bodies in its wake.
15
@who This article's main indictment of such treatment is not that it is cruel, but rather that its ineffective. How many of those 200 Seattle deaths last year were overdoses after some form of civil commitment?
4
@who The article does not advocate letting people with addictions "die on the streets". Believe me, I understand that Seattle has a problem (as does Portland). The relevant comparison is between the involuntary addiction treatment described in the article and other forms of treatment (some described in the article) that put choices in the hands of the people dealing with drug addiction. From what I can tell, the problems faced by Seattle are due to stopping an ineffective approach, but not fully implementing any other approach. PS stop blaming 'progressives' when you don't want to pay for actual solutions.
4
Just to point out that the implication that drug abuse is the only health problem for which people can be incarcerated isn't true. In a number of states, people unwilling to get treatment for tuberculosis can be incarcerated and forced to take medication for this.
4
@Steve
Tuberculosis is communicable, but drug addiction is not. Patients with tuberculosis who refuse treatment are a public health risk, which is why they can be confined for treatment. There is no equivalent public health risk for patients with drug dependence.
4
If my brother had been sent for involuntary addiction treatment, he might not be dead of multiple organ failure brought on by years of alcohol use disorder. Instead, he is dead at age 54.
6
On top of all the ills catalogued in this piece, let me add a larger view. We are only just starting to scratch the surface of the spectrum of substance use disorders. For too many years we have looked at the behavior rather than the causes. We have decided to criminalize a spectrum of disorders because we don't understand them but we sure know how to get these annoying people out of sight for a while. And we do next to nothing in prevention research. And, along the way, administrators of recovery programs pull in hefty salaries from state and federal contracts. Our approach to the spectrum has been and continues to be primitive, costly and only occasionally effective.
4
Well of course those who 'voluntarily' enter treatment will have better outcomes. They are obviously more motivated and serious about recovery. But a "suspension of civil rights" can save lives and that has been recognized as a bedrock of our treatment system when one is too ill to make lifesaving decisions on their own such as involuntary hospitalizations for mental illness. The mentally ill are quite frequently dually diagnosed with drug addiction. Do we leave them on the street to freeze to death with their drugs so as not to "suspend their civil rights"? Yes to ethical and effective care which is expensive, but the mentally ill / drug users will more times than not refuse to go willingly.
12
@NYer You set up a false equivalence. These authors do not argue for leaving people to freeze on the streets. Rather, they argue for a more enlightened and comprehensive approach to treatment, acknowledging that coercive abstinence is not effective and likely does more harm than good. After all, if you save someone from freezing to death by placing them in coercive abstinence program, only to have them overdose upon exiting, what have you actually achieved? Coercive abstinence treatment is not the only, and certainly not the most effective, alternative to leaving the addicted on the streets.
5
@AJF What do you propose as a more effective alternative for those who refuse to undergo voluntary treatment, or cannot afford it? Even if the success rate is low, isn't that better than leaving people on the street?
1
@NYer Force is NOT a first response to sickness. Not even close. If clinicians aren’t able (or willing) to develop protocols which earn their patient’s consent, they’re failing at their jobs. The public purse should NOT be raided to fund their incompetence and brutality.
If I had a child who was addicted and did not want help, I would be so grateful if he or she were forced into high quality treatment. Addiction is a progressive disease that if left unchecked can result in death. Someone in this thread said that comparing voluntary treatment to involuntary treatment is not the issue. The more apt comparison is between someone who refuses help and is forced into treatment to someone who refuses help and is left to fend for themselves. I agree with examining this comparison. To me it is just too frightening to set an addict free knowing what the consequences might be.
8
I am a board-certified psychiatrist. What is called addiction is a pattern of behavior, not a disease. Hence, "treatment" is a misnomer. Jailing people who do not harm others should itself be a crime. To understand the whole mental health field, you must think like a sociologist, and do not neglect to follow the money, from therapists to psychiatrists to the "treatment" facilities. And, educate yourself, and think for yourself.
21
@Radical Inquiry
I am a Rehabilitation Counselor and an NYS Licensed MHC (ret). Yes, addiction is a pattern of behavior, but one that becomes so deeply and cruelly imprinted upon the brain that attempting to altar the pattern becomes a neurological nightmare, hence the extreme relapse rate. Whether you call it 'disease' or not does not alter the fact that once 'addicted' people are so drawn to the power of the drug, including doctors and psychiatrists that they are willing to risk their lives for a 'fix' knowing well the price they will inevitably pay whether in overdose or the perils of addiction. Perhaps it is the stress and intensity of modern life, but whether it be alcohol or heroin, simply trying to relax and turn off the stimulation for a little while has become an increasingly dangerous chore.
12
@Radical Inquiry
I respectfully disagree with the good doctor. Alcoholism, or alcohol addiction, many decades ago was classified as a disease based on extremely good longitudinal studies and other studies with genetic twins that showed without a doubt that there is an extremely strong genetic component to alcoholism. When I finally grasped that knowledge and understood that I was no different than perhaps a person with type 1 diabetes, it helped me immensely in recovering from a disease that destroyed my life. I credit that wonderful scientific knowledge, in part, with allowing me nearly 34 years of continuous sobriety and clean time. While the jury is still out on whether there is a genetic component to drug addiction, there are studies that point to a similarity with alcoholism. We should ask the people who are forced into mandatory treatment and who get clean and sober whether they feel it was cruel and unusual punishment or whether they feel it was an intervention that saved their lives.
8
@Radical Inquiry
The DSM-5, the handbook of psychiatric diagnoses, lists substance use disorder, its name for addiction, as a disorder the same as all the others including schizophrenia, major depression, and bipolar disorder.
Unless you don't believe these others are also diseases, obviously you disagree with most other psychiatrists as to what they consider addiction to be.
6
I doubt that many of those who have commented on this article remember the bad old days when thousands of people who were mentally ill or addicted to drugs or alcohol were locked up for years or even decades in state mental hospitals.
I'm old enough to remember those days. In fact, I did professional training rotations in two of those hospitals.
They were terrible institutions, and expensive to maintain. So geniuses like California Gov. Ronald Reagan decided to close them without providing adequate housing, psychiatric or medical care, or social services for the former patients. Many of those patients wound up on the streets, homeless and hopeless.
Chaos ensued. The brilliant solution to this self-inflicted crisis was to arrest the crazy people, addicts, and alcoholics who became too bothersome and to "treat" them in jails and prisons, while leaving the rest to fend for themselves. Decades later, we're still making the same gigantic mistake.
Ponder that next time you come across a disheveled addict or a raving "Napoleon in rags" out there on the street, and you feel fearful or disgusted but you don't feel guilty because you don't know that we as a nation put him there and abandoned him.
And please think again if you believe that people who need help with mental illness or addiction deserve nothing better than imprisonment. We imprison them not because it's a good solution, but because as a society, we're inept at dealing with this problem.
48
More endless discussion saying the same things over and over while thousands die. Politicians say this research says that experts (experts on what?) say something else. Blah blah blah . When I was in my 20's I lost a number of friends to drug problems and in recent years I have been helping some younger people to get help often from all these wonderful organizations and agencies that are supposed to help-the ones that put them on waiting lists. Waiting lists do not cure anyone. There is a methadone clinic in town that it is hard to reach because they prefer not to deal with the "riff raff" I could fill pages with some real facts but only one is important-These people can be helped-it is totally possible-not just the ones with endless supplies of money but regular people and they can go on to lead not only regular lives but really productive ones. All this talk and psycho babble and political posturing is a total waste-and people are dying. I know it is a multi million dollar industry - millions are spent and few are cured but something must be done. Well they are looking into the drug companies and blaming it on them or the so called docs that over prescribe-yeah maybe a little-making it so difficult that people-especially older people that may require actual pain medication have trouble getting it- what moronic policy is creating that situation? Is there an adult in the room? someone with the sense to make this right? I hope so because this is killing people every day.
2
The description in the article is horrific, but the picture seems to tell a much less jail-like story.
2
Correct ethics requires totally informed consent. Beletsky and Tomasini-Joshi have make clear that it is absent in coerced treatment programs, violating the victim's autonomy.
The authors' recommendation, "a more profound cultural shift to embrace solutions that are both scientific and ethical", is par for the NYT. It doesn't go to the core.
A better way to understand this issue is by examining what government brings to the table -- force. This underlies a large number of problems the NYT has railed against, ranging from the Yemen Holocaust, the persecution of Assange, the harming of immigrants, especially children, etc., etc. -- the issue of the state's "rights" and interests vs. humanity.
If we study Plato's government or that of other philosophers, we can imagine government that respects the red lines. But, if we study government the poli-sci way, and also history, we can understand its impossibility.
So, yes, sure, let's have a "profound cultural shift" -- why not? -- but, it won't solve the problem of government menacing humanity.
5
Leo Beletsky and Denise Tomasini-Joshi deserve praise for highlighting the human rights violations, where innocent people are jailed, and subjected to treatment without consent. This is intolerable and unacceptable.
Whatever the motives of the violators, they are suffering from the mental illness of "powerism." They're a clear and present danger to others, such as those who overdose as a consequence of the involuntary treatment.
We should urge everyone with "powerism" to get help for controlling their mental illness, and we should use correct force to protect society from their human rights violations. When victims overdose, the responsible perpetrators should be held responsible for full restitution as well as punitive damages to deter blatant violations in the future.
3
Treatment needs to be looking for the root cause: most likely loneliness, isolation, lack of community and purpose. Lots of addictive behaviors are fuelled by a society which celebrates hollow goals. People aren't getting what they need to fill the hole. How do we change that?
22
@TW
Yes, those things can exacerbate addiction. However, none of those things can make someone into an addict of any sort. There needs to be an underlying genetic disposition for someone to become an addict.
3
@TW Root cause?
Just like the gin addicts in Dickens' England much of the addiction seen in our own society arises from limited opportunities, lack of jobs and economic stress.
PEOPLE ARE TRYING TO ESCAPE LOUSY STRESSFUL LIVES.
2
@TW
The root cause of addiction is the addict's need to feel the high of whatever rushes through his veins. Society has nothing at all to do with it. The "hole" is when there's no drug in the body. No one fuels his journey. He moves from his own need. And he dies or sobers up.
2
To revise the analogy, it'd be more like forcing a relative who has refused for so long to do anything about their diabetes that they're staring down the barrel of amputation, blindness, cognitive impairment, and an early grave to go to a "care facility" where there's no sugar--but also no dietitians equipped to help them make effective changes, even if they did want to.
Still absurd, but now you can see why people are so desperate, yes?
The article's link claiming to support that involuntary commitment is more dangerous doesn't go to the real source; it goes to another opinion piece. But in any case, it's not a comparison that can be made. Of course people who have been signed off on by professionals as in danger of harming themselves are more likely to harm themselves. And of course voluntary treatment is the most effective--because the people who volunteer actually want treatment.
Judges should get out of making specific care decisions, certainly. And it's a travesty that some people are forced into "involuntary" treatment because they do want help but they don't have access to timely and affordable voluntary treatment. But, "How do you help people who want help and are not in imminent danger of death?" is a different question from, "How do you help people who don't want help and ARE in imminent danger of death?" They don't have the same answer. And certainly the second does not have as simple and obvious an answer as the author of this piece claims.
3
As a psychiatrist who assists those with mental illness and opioid dependence, I can attest to the great difficulties associated with coerced treatment. These authors identify limitations in outcomes compared to voluntary care, fewer respond, more will die. So how many need to have their rights taken away to help one person? And how many more will die to achieve one recovery? Who wants to be forced to do something against their will? So how many avoid detection so as to avoid coercive undesired care pushing the community of people with the disorder further underground? When coercive measures empower some to over-ride the wishes of others, how often do fair, person centered if not customer friendly care also become inconvenient if not too cost prohibitive to provide? How much abuse or neglect is the result? How many creative ways to improve care go untested, unused? And don't misunderstand, this power is corrosive on the physicians who try to be ethical while obligated to force their will on those deemed in need by others. I can empathize with the many who are eager to help and their paternalistic impulse. But as with any liberty, obliterating it is often paid at a terrible price. And that price in failed treatment, excess deaths, hiding from care, compromised ethics if not outright abuse might just be too high.
6
@David Greenspan - I can see that one person could be inconvenienced by being coerced into treatment. So, rather than coercing them into treatment we allow the mentally ill and addicts to destroy the lives of 100's of citizens who are leading average lives of going to and coming from work, school, running businesses and or using our parks for recreation.
So, the city or county of Los Angeles has decided NOT to build a hospital / concentration camp for the often arrested, mentally ill, drug and booze addicts. I wish they could build a hospital or concentration camp for the 10,000,000 people living and working in Los Angeles City and County where we'll be safe.
4
@David Greenspan
Thank you so much for your honesty, Dr Greenspan. May I add that your argument in favor of respecting individual rights can be precisely transposed to the proposed "red-flag laws" taking away guns from people who might (might!) use them to commit suicide, or limiting free speech to those expressing politically incorrect views, or even refusing to participate in the Orwellian Two Minute Hate. As you say:"..as with any liberty, obliterating it is often paid at a terrible price.."
@Steve Sometimes exaggeration for effect works, but this is completely in appropriate.
Concentration camps, are you really advocating for the creation of concentration camps?!? "We allow the mentally ill and addicts to destroy the lives of 100's of citizens..." Well if that's not hyperbole, I don't know what is. But even assuming its true, the flip side is also accurate: "the 10,000,000 people living and working in Los Angeles County" (or any county) have destroyed the lives of the least fortunate among them by failing to step up as a society and provide the safe and effective treatment necessary.
Anything to fill those jails... Once you build them, you've gotta make sure they come.... how much is the taxpayer being charged for the course of "treatment" ? What are the qualified professionals, including medical professionals and substance abuse counselors with relevant training, are working at those jails and attending to the patients ? Why are outcomes not tracked to measure the effectiveness of the "treatment" ? Are methadone and other medications which are shown to reduce cravings offered to those affected ?
6
I wonder if there is a financial incentive to rebrand jails as treatment centers? Are states or private prison contractors billing the federal government for "medical care" to cover the cost of mass incarceration?
8
I'm a public defender in Massachusetts, which means that it is my responsibility to represent people who are subject to petitions for involuntary commitment. My last task in court today was representing a young man who had been arrested on a Section 35 warrant. The petitioners were his two sisters, who loved their brother deeply, and were terrified that he was going to end up dead if he didn't get help. When these two women saw their little brother led into the courtroom wearing handcuffs and ankle shackles, they cried out "why is our brother in chains?!" Their voices were full of anguish and rage. They told me after that they had wanted their brother to get help, so they had gone into the courthouse to fill out the Section 35 application. Nobody ever told them that the police would be sent out to arrest their brother, handcuffing him like a criminal. Nobody told them that their actions would cause their little brother, who has no criminal record, to end up locked into a cold, filthy jail cell under the courthouse for hours, scared and alone. They certainly never thought that he would be on his way tonight to a glorified jail masquerading as a detox facility.
I believe that involuntary commitments are a necessary evil. But people like my client's sisters do what they do out of love and desperation. They expect the police and courts to treat their loved ones with compassion and care. Instead, we treat these people no different than we do criminals. We need to do better.
73
We shouldn’t be treating criminals that way either.
17
@Rudy Breteler
So now that the previously ignorant sisters saw the consequences of their actions, do they have the right to retract their request? If not, they and any similarly well-meaning do-gooders might usefully educate themselves before dispatching their relatives to jail. My sympathy is 100% with the brother in this case.
2
People will seek treatment when they are ready. Or they will die in the meantime. That's the harsh reality. Forcing 'treatment' is not helpful. We need better support when people are ready to make the change. The money spent on forcing treatment would be better used to help people who want to change.
14
I’m sorry to have to say this because I applaud all of your efforts to make the public aware of the opioid crisis. I have attended many events and community efforts to spread awareness. We have donated sports equipment to juvenile treatment centers and held candle light vigils.
Until the reality of the cost involved to help your child through rehab, nothing will touch this horrific time in our country. Thousands of dollars was spent trying to help my son...Wilmington Treatment center, Dart Cherry court ordered prison treatment programs, transition beds, half way houses, monthly probation payments, ankle monitoring cost, courts costs, bus fair, prison rehab phone call costs....We lost him anyway with nothing to show for it. We are entrenched in a system that does not work no matter how many times we bang our heads against the wall.
My family will never recover from the guilt of thinking we could have done more. Nor the anger after every failed rehab stint.
26
Many states are going down the same road as Massachusetts — strengthening their civil commitment laws to hold people against their will so they will get treatment.
And some researchers, such as Leo Beletsky of Northeastern University, say more families are choosing to have loved ones locked up because it's the only way to get immediate help.
"Limiting someone's civil rights should be the last resort and only reserved for those cases that are truly dire," he says.
In my travels I’ve heard about addicts being whisked off the streets in Mexico, Costa Rica, and Other Latin American countries. The addict is forced and imprisoned in a facility to get sober/clean. As a recovering person for over 30 years, I felt this was barbaric. Now, I’m reading about jailing addicts and forcing them to accept treatment. First, legally , if they haven’t been charged with any crime, how are they being held against their will? Even for mentally ill people, getting an involuntary commitment usually doesn’t exceed 24 to 36 hours. So I’m very curious as to how they can “force” someone to treatment . Very often an addict is given a choice..jail or treatment... which is at least a choice. In some cases you can lead a horse to water ..you can’t make him drink....but, you might make him thirsty. However, forcing an addict into treatment is not conducive to long term sobriety.
7
Seems drug use is being decriminalized, now we can't do anything until they commit a crime. This is invitation to chaos we're seeing in "progressive" localities were the fruits of these cockamamie policy are being felt.
3
Many of the commenters missed the part where the authors talk about medical treatment. Many people with addiction need medicine like methadone to recover. Jail is not the answer.
12
And what is 'The Treatment' ? It usually nothing more than 12 Step Groups. Which is a Religious/Spiritual approach to Addiction. You go to endless meetings were people talk about how bad using drugs was for them. Then you hang out after the meetings and chain smoke. Marijuana use is unacceptable but huffing cancer sticks is very 'cool'. Some people do really well in this Cult-like environment but others are driven to relapsing and dying.
14
"Civil rights violations in the name of “treatment” are still violations. And jails called “treatment facilities” are still jail."
Are prosecutions of and punishment for criminal acts civil rights violations?
A treatment facility is clearly a better option than placing addicts in general population of a jail or prison and certainly better than leaving them on the streets.
2
This model is a sop to the increasing number of Americans who love to believe problems can be solved with cruelty. (They can't.) Addiction is a complex condition with good treatment options -- alternative mind-altering substances that quiet the craving and allow people to function -- that just aren't medieval enough to satisfy the bloodlust of people who don't understand addiction.
We will do better when we move sadists out of the chain of command when it comes to solving social problems.
14
Perhaps the authors of this article missed the very recent article detailing how the opioid epidemic has triggered an outbreak of HIV through shared needles.
Is 'involuntary addiction treatment' a valid clinical definition?
3
What a poorly written article. To compare drug addiction to diabetes is ridiculous. Drug addiction has very serious consequences for society and this gives society a very good reason to defend itself. A diabetic that refuses treatment hurts only himself and he has the right to choose . And then , the authors compare the results of voluntary and involuntary treatment: a ten year old knows you cannot do that.
13
@MS
Well then apparently I am not as smart as a ten year old. Do please explain to me why "you cannot do that".
5
@magicisnotreal Because the addict, on his own, must want, desperately want treatment. Until this happens, programs like this are mostly useless.
1
Because the groups you are comparing have to be similar . Suppose I compare the grades of children who go to school with enthusiasm
with the grades of children who hate school; would you trust the results?
The Serenity Prayer is something the involuntary treatment advocates don't know properly.
Much of dealing with addiction and addicts is about learning to know what you can and cannot control.
You can dry someone out involuntarily, you cannot force them to get sober involuntarily.
Harshness in "treatment" is frequently a trigger to defiance and a binge of more than the usual amount of self destructive behavior.
14
I've had addicts in and around my life, and since the author seems to have missed it, here's the point of forced treatment/jail: you get the addict away from the lives they're ruining via their addiction.
I've watched addicted parents try to destroy their children's lives and addicted children destroy their parents lives (just wait till you get a friend with an adult child who can't stop the addiction but keeps needing their mom to come find them in alleyways and pick them up from real jail and call the police every time they overdose and disappear). There's no such thing as an addiction that hurts only the addict. So even though ruining the lives of your loved ones isn't technically a crime, I say nobody needs a reason to get a respite from the hell wreaked by an addict.
44
@Claire
If what you say is true that is false imprisonment.
Maybe think first?
The failure of people in the addicts life to set hard boundaries and enforce them is not a job the government exists to do for you unless things have gone so far as establishing a no contact order. Then you can have the police pick them up. But that is for violating the order not to give you a break from them.
6
@magicisnotreal
"...give you a break from them?" How about addicts who 1. steal their parents money and car keys and drive drunk, and their parents refuse to prosecute? 2. effectively schmooze police to disregard a no contact or no trespass order to permit such recidivist behavior? These ruin families and endanger the lives of innocent people.
8
@Claire
Hard to imagine the pain of having a friend with an addicted adult child . Do you hear yourself?
3
People who undergo abstinence based therapy (such as the involuntary treatment model) have a greater than 90% relapse rate. People who are treated with the gold standard treatment, either methadone or Suboxone maintenance therapy are much more likely to regain control of their lives. The comments for this article make me feel deeply sad. So much hate and contempt for people suffering from addiction. So little understanding. Addiction is not restricted by age, sex, or class. It happens across the spectrum. We know what works, and we know what does not. There has been a huge amount of research in this area. Medically assisted treatment works. Abstinence and 12 step programs rarely work for opioid addiction. Of course, for those commentators who see those addicted as animals, as inhuman, as not worthy of compassion, none of this matters. Hopefully you will at least have some more compassion when somebody you loves becomes addicted.
40
@Kevin Friese I've known dozens of people who quit heroin addiction via abstinence and 12-step. Try going to a Narcotics Anonymous meeting sometime.
1
how does this compare to jail for drug offenses?
2
Of course voluntary treatment is better! Of course outcomes are better. But if somebody is in the criminal justice system, they’ve passed the voluntary part. Ideally, they should have a voluntary treatment option, but what happens when the lure of the high becomes stronger than the stick? Oftentimes people need a sustained period of sobriety before they’re really able to see the need for/ accept the treatment. The only way to get that might be through the criminal justice system. It would be fabulous to have access to better treatment so that people would not have to get to the point of criminal justice involvement. But where we are right now, this is a far better option than sitting in jail.
4
@Andrea
What do you see as the differences in this vs jail that makes it a better option? To me it sounds like jail with a different name.
5
Forced treatment strikes me as a better option than turning someone loose on the streets to get high and possibly overdose — possibly neglectfully leaving small children home alone or with unsuitable babysitters. Addicts all too often steal from family members or commit burglaries or auto break ins to pay for their habit. In this particular jurisdiction, drug possession actually is a crime or misdemeanor. What is needed are more paid treatment options and more options for families and the courts to make them get treatment. There are a few low cost options, but not enough.
7
@Bookworm8571
I think you missed the point of the article. Jail is not treatment and it doesn't work. When the person is released they relapse and nothing is solved.
4
@Mitulf
I guess we will have to agree to disagree. Perhaps we have a different definition of the word "works." The authors quoted a study that found that people who were involuntarily committed "were more than twice as likely to experience a fatal overdose as those who completed voluntary treatment." They are also noted that "Lower levels of tolerance makes the risk of fatal re-entry astronomically high." They Did Not say, for example, something like "a longitudinal study found that involuntary incarceration (I refuse to say "treatment") cut drug relapse over a one year period but only half as well as voluntary treatment." As a psychologist that has worked with drug addicted teens I can assure you that throwing an addicted individual into jail for cold turkey detox is not treatment. The ethical issue of incarcerating an addict for being an addict is only a separate issue if you believe that there is no psychological harm in treating addicts like criminals. First do no harm.
2
Addicts don't really bother me. Paying for cops and prisons does. I live in a neighborhood overrun with homeless addicts and I don't really find them that much of a nuisance -- less of one than uptight "law-abiding" neighbors, to be sure. If it's hurting families then families should pay. It isn't hurting me, and this approach looks really expensive.
4
Shocking! Unconstitutional!
4
Having been a licensed psychologist, until my retirement, any psychologist who participated in these kinds of "treatment" facilities would face disciplinary action for violation of the ethical codes that govern psychological practice.
I would imagine that involuntary commitment for substance abuse disorders would violate the ethical codes for any professionals who worked at them.
15
My recommendation for Leo and Denise is to go volunteer at a homeless shelter. There you can actually see why your piece is so misguided. There will be plenty of the homeless for you to interact with and you will understand that homelessness is often a matter of both serious mental illness and drug addiction. Get your hands dirty! It will help you understand that forcible treatment is the only solution for these unfortunate people. They are there because they refuse treatment.
16
@marie
In Los Angeles, which has a significant and growing homeless population, the most recent research finds that 71% of those without homes do not have either mental illness or substance abuse problems. What they have is a terrible lack of affordable housing. The correlation between the cost of housing and the number of people who don't have homes is quite strong. Last year, the county agency responsible for serving the homeless reported 80% of their clients were brand new to the system. These aren't chronically dysfunctional people (who don't deserve your "they refuse treatment" oversimplified condemnation), they're people who fell off the county's perilous bottom housing rung. Given the stats that close to half of Americans can't come up with $400 in an emergency, it's not hard to imagine someone's medical mishap resulting in missed rent or mortgage payments.
Please stop carrying this victim-blaming message. It's untrue, and although it might make you feel superior, it's not helping. People who don't have homes aren't different than the rest of us, just less fortunate. I think Jesus spoke about this very thing.
5
@marie
Please stop equating homelessness with mental illness.
Despite your present circumstances, it can happen to you, too ...
4
@marie What makes you think they haven't? Do a little research. Both are deeply involved in the communities they write about and have worked providing legal and health services to individuals including those who are homeless, have a mental illness and/or use drugs.
1
"people who were involuntarily committed were more than twice as likely to experience a fatal overdose as those who completed voluntary treatment."----Isn't this selection bias? Why not compare outcomes between those who decline treatment and receive none and those who decline but are involuntary committed? I imagine everyone recognizes that voluntary treatment is better than involuntary treatment. So a study that "proves" voluntary treatment is preferable really doesn't advance our understanding. The question to be answered is, how do those who refuse to volunteer for treatment and receive none fare versus those who are involuntarily committed for treatment?
30
@Robert
If an addict is continuing to use, the overdose risk is lower than if the addict becomes abstinent and then relapses.
Medication therapy with methadone or suboxone reduces this risk.
7
I have two friends whose children -- both in their 20s -- died of opioid overdoses. This type of approach might not be ideal. But if it saves lives DO IT.
11
@John Jabo
Did you miss this important point?
". . . research suggests that involuntary treatment is actually less effective in terms of long-term substance use, and more dangerous in terms of overdose risk." It doesn't work.
2
Why should the forced treatment model be limited to opiate drugs? It could be effective against the drug that kills more people than all illegal drugs combined (plus firearms). Withdrawal from nicotine takes about 2 weeks; after that an addict has moments of intense craving, but they become less frequent over time. After smoking, the telltale metabolite of nicotine, cotinine, is present in urine tests for at least 4 days. Smokers who are motivated to quit could voluntarily sign a contract specifying that they will spend 14 days as an inpatient at a rehab center and submit to periodic urine tests thereafter, with further compulsory treatment in case of relapse. Thousands of smokers would agree to this treatment and thus countless lives could be saved and sickness averted. Similar methods would help the morbidly obese.
5
Re-branding jails as "treatment facilities" reminds me of what happened many years ago: Prison guards were re-branded as "corrections officers".
America is in serious need of a reality check.
7
@Alan R Brock
How about changing the name from "The Department of War" to the "department of Defense"!
No one can be opposed to defense!
5
The Department of Defense was formed by the merger of several cabinet-level departments, including the Department of War. It was not simply renaming the department.
These people are criminals. If they are in possession of an illegal drug, or a legal drug obtained illegally, they have committed a crime. Stop brushing off possession and usage as normal behavior. The stats stated in this article support your premise while dismissing others that show abstinence works for a lot of people.
Many addicts live in abysmal conditions; lie, steal, cheat and sell their bodies for the next fix, yet don't want to be helped. Forcing people into treatment is not a bad idea. Pretending that addicts are not criminals, like Seattle has done, makes the city unsafe for law-abiding citizens. Forcing people to get the drugs out of their system is the first step for getting them into treatment.
The sickness model of addiction absolves the addict of responsibility. Stop coddling the criminal drug addicts and lock them up to start them on the road to recovery even against their will. This was never a problem when society saw addiction as a black problem. White addicts are not less guilty.
27
@S.L. It's not either or. They can be both criminals and sick. They can need incarceration (for the protection of the rest of us until they are no longer a danger) and also treatment. So if they are committing crimes, it should not be difficult to every t and dot every i legally and only hold them (in a jail that is also a real treatment facility) either pending charges or upon conviction. There is no need to take shortcuts that are a slippery slope.
4
@S.L. Saying addicts are criminals is extremely ignorant. Overall, alcoholics cause more problems than addicts and are not considered criminals since alcohol is legal. Involuntary confinement does not work. An addict has to want to get well.
27
I’m very sorry to read that you feel so strongly that becoming addicted to pain medication /opioids is a choice. It is misunderstandings like this that has hampered the resolutions needed to fight this ongoing crises.
I lost my son three years ago after fighting for over 10 years. It has been a silent killer for over the 13 years that I know of...He became “addicted” in the 9th grade when he and his cousin stole opioid pills and fentanyl patches that his mother was prescribed for back pain.
Little did the boys know that they would become addicted within five days. My son lost his battle; our family lost the war, he overdosed on heroin laced with fentanyl.
14
Sorry to say, but we cannot seem to rid ourselves of our puritanical genetic history. Jailing people with drug addiction disease is no more useful than if we were to jail people who overuse alcohol. We allow alcoholics to roam freely, drive cars, teach our children, and take care of our sick families among other things. Why such different treatment for drug addiction and mental illness? Could it be that the made-for-profit jails need to be inhabited for their investor's sake? If so, then let's incarcerate everyone we don't like or understand. We can start with those running the country at the moment.
94
@Figgie Ugh, there's a reason why the holding cells in jails are called "the drunk tank." When people are intoxicated and likely to be a danger to others we do in fact lock them up. Additionally, most alcoholics can roam freely, etc because they are "functioning" alcoholics. Our society is full of functioning drug users who are not locked up. It's when one's addiction makes one a nuisance or even safety threat that more punitive measures need to be taken to maintain a decent, orderly society with clean, safe streets, etc.
41
@JP
The “drunk tank” is so Andy Griffith. Where you end up after an ETOH pullover is a function of geography, class and race. Results of poor and drunk/high driving not generally the same as wealthier/locally prominent and drunk/high driving.
3
@JP The article starts with the caption "Convicted of no crime..." Are you saying we should be willing to create a precedent and forgo our civil rights so you can lock up those who are a nuisance to you? You do know that "drunk tanks" don't really exist outside of fiction. Alcoholics are put in jail when they break the law like anyone else and they have had the benefit of due process.
3
I think that this article has good intentions as it attempts to shed some light on the squalid conditions of treatment facilities, especially those located in Massachusetts. As much as this might be an issue, I think that this article fails to take into consideration the positive effects that have come from these facilities and the fact that there are very few other ways of combating such a horrible disease on such a large-scale platform. I agree that there are medications or practices that could be put in place to eliminate the struggle for some addicts so they do not have to go cold turkey in their recovery process such as weening patients off of drugs, encouraging new lifestyles habits to replace the unhealthy ones, etc. With all of that being said, addiction is an ugly disease that takes a toll not only on the person who struggles with it, but their families and friends, as well. Without these facilities the only option for addicts would be to voluntarily subject themselves to treatment, which may never happen.
I would be interested in comparing the number of people who are subjected to involuntary treatment and subsequently overdose afterwards and those who survive and stay sober for the remainder of their lives. I think knowing both of these facts instead of only the first one (supplied by the author) is important in ultimately establishing whether or not these facilities truly work, despite how inhumane they may seem. If they work, they work.
6
@Jillian W
As mentioned above in response to someone else, relapse and overdose occurs significantly more in people who are treated with abstinence than those on medication therapy
4
So what are the families of addicts supposed to do? Most of the time addicts won't seek treatment on their own. Either they're mentally incapable or they simply don't think they have a problem that needs fixing. These people are burden on their families at best, and at worst a serious danger to everyone around them. Anyone who has had an addict in their family knows the terrible pain of trying to help a loved one that not only doesn't want your help, but hates and rages against you for trying to give it.
I lost a cousin to opioids, first she ran away from home to live on the street, after the family staged an intervention, then later was found dead, overdosed. When the family made it clear they would no longer enable her addiction, which had nearly impoverished her household, which included her infant daughter, she abandoned the family. To her, using was more important than loved ones, she did not even think she had a problem. She blamed us for trying to ruin her life.
So I have no sympathy for addicts remanded to involuntary treatment. It's for their own good, and it spares their families from having to deal with these people, who are by and large ticking time bombs waiting to explode.
21
@Joel I am surprised you still defend the intervention/treatment/tough-love approach, even after your family's use of it resulted in (or at least did not prevent) the death of your cousin.
It isn't that that forcing addicts into treatment is always bad. The problem is that the U.S. seems to be incapable of dealing with the disease of addiction without a judgmental, moralistic attitude pervading everything. Maybe if we had the treatment centers of Austria or Denmark at our disposal, forcing people into treatment might have better outcomes. Instead, we have confrontations and "interventions" in which families threaten to withhold love, we refuse medications, refer to them as "inmates," and force everyone to use a treatment system based on Christian theology about the fall of man (even court-ordered programs!). It isn't so stunning that we are bad at this. If you had a tumor on your leg, they would want to shoot it off with a shotgun at high noon, and tell you to quit crying, it's your fault, you shouldn't have spent so much time in the sun. Would we be surprised if leg tumor sufferers avoided the doctor?
Joel, the honest truth, is that some people get so buried by drugs that nothing can stop it. But if your cousin had lived in a place like Switzerland with good compassionate treatment, she would have had a better chance. There would have been less to fear. I hope this article illustrates part of the justifiable reason why your cousin may have feared treatment so viscerally.
15
@kgdickey
Anyone who has addiction in their family knows that the only viable option is tough love. It doesn't always work and may end in tragedy, but every other alternative simply enables the addiction.
12
@I want another option
That's wrong, incorrect, untrue, and a nice way for tapped-out families to feel justified in abandoning the sick people in their midst.
As other countries, and meds-based treatment in the US attest, there are kinder and more effective treatments out there. But that would deprive the holier than thou crowd of the dopamine hits that keep them going, so.
6
Prison is prison is prison. They're run by departments of corrections. Some are even called correction facilities with no indication what they are trying to correct.
There's a local company where poorly paid workers must pass a probation period. That period is call "corrections". Once off "corrections" workers continue to work under the threat of going back onto "corrections" until their work is satisfactory.
Prison or a poorly paying job... neither seem to suit the needs of a contemporary society.
4
A picture is worth a thousand words.
Immediately I noticed in the photo that the inmates appear alive.
They have a much better chance at recovery that way.
Despite criticism from this piece, attempting to save the life of a suicidal loved one remains a virtue.
The CDC latest stats report 70,000 drug overdose deaths in 2017 which suggests that voluntary discontinuation is not highly effective for many.
Comparing diabetics to folks who die by the thousands because they can't quit addicting drugs is worse than not persuasive.
23
@sjm Enforced sobriety is simply not effective. Over 90% of people who receive abstinence based treatment will relapse. I imagine it must be even worse for those forced to abstain. Should we commit type 2 diabetics who refuse to lose weight to prison to force them to lose weight? That would help deal with their diabetes better than medication. Perhaps if we made treatment available to the people with addiction who currently can not afford it, rather than simply locking them up for a short period of time with no actual treatment of the underlying disorder, we would be moving forward. Yes, incarceration keeps people alive (but in prison). But it does almost nothing for their long term health. Unless you believe they should just remain behind bars. If that is what you believe, then you don't really care at all about the people, you just like to moralize the problems of others you look down upon.
8
When it comes to this type of addiction a holistic approach won't work.
It is tough to fight the addiction, but actually kicking it cold turkey has helped many people in the past who had a brutal but effective withdrawal.
Small towns and rural areas have been bankrupting themselves spreading around the narcan to no avail.
I have no problem with going after the pharma companies, bur getting these addicts through withdrawal is a downward spiral of money when many relapse multiple times.
If they're families care for them let them pay for holistic options or fancy facilities, but the chances these addicts are going to be productive members of society again are low, so offering them this type of prison environment where they are off the street is a gift to begin with.
They will no longer be a threat to the hard working taxpayers via being homeless or commit crimes for awhile at least.
10
@marie
So we should lock them up, but only the homeless ones. Do I have that right?
1
@raph101 Yep, that’s right.
1
@raph101
Not just the homeless ones but any that have been hassling the public or become violent.
I think that the homeless in general should be off the streets also and in some jail or building,
they should not have the right to destroy the public spaces.
The only people that have a reason to be on the streets are the mentally ill or the vets with ptsd, and they should be given help and moved off the streets.
I don't have any patience for the lazy, the alcoholics, or the drug addicts in general, they all chose to take that first drink, or take that first drug they should be jailed and not allowed to be on the streets.
The drug addiction has been complicated by the opioids given out by doctors but if you are on the streets most likely you have refused other help before you ended up here.
Look at the cities that have now become disgusting San francisco seattle and portland the tax payers should not have to put up with the homeless enclaves that are allowed outdoors in these cities
1
It's pretty clear that this piece was not written by anyone who has dealt with an addict. The diabetes comparison is ridiculous. A newly diagnosed diabetic isn't going to steal and lie and become violent against family members when they are prevented from acquiring candy. When they can't get their food of choice, the diabetic isn't going to drop out of school, quit work and resort to crime in order to buy their junk food. Oh! How about how the diabetic isn't going to destroy relationships among family members, friends and basically anyone who has contact with them.
Listen to this: I wait in fear every every day for the phone call that my addict has overdosed. I wish so much to be able to force my addict to a treatment center.
86
@marie, perhaps you should read the article again. One theme is that this type of “treatment” has a terrible failure rate, including a very high risk of fatal overdose when the person is released. Perhaps someone will suggest permanent involuntary “treatment” as a solution. I sympathize with the damage an addict causes, especially to others, but “lock em up” (and maybe throw away the key) is deeply offensive to our system of values and law.
12
@Dagwood, who is suggesting permanent involuntary treatment or locking them up and throwing away the key? Very dramatic! But, serious addicts are a danger to themselves and others, and you can't ask a sick person to make good decisions about their treatment, because they won't. They need good quality evidence-based care, and in many situations it could involve a forcible commitment. What do you suggest? Letting them destroy themselves and others? Isn't that offensive to our system of values and the law?
17
@Dagwood
Addiction of any kind is insidious. It’s a brain disease - a physical malfunction. The result is behavior that is “cunning and baffling,” as they say in AA. A “terrible failure rate” goes with the territory, and relapse from opiates is always particularly dangerous. As with any approach to ameliorating the effects of mental illness, there is no perfect solution, and every approach has its downsides.
6
There's a couple big problems with this article, and with the previous article the author published and linked here. First off, upon examining the study the author linked claiming that involuntary commitment is less effective, it appears the author simply made that claim up. The study linked explicitly states their quantitative results, with the number of studies claiming involuntary commitment helps and harms being equal, with the majority being inconclusive. How that equates to treatment being less effective (or how both the times and the previous publisher of this author allowed this blatantly false claim to get through the editing process) is beyond me. The second big claim - that incarceration is correlated with overdose deaths - is similarly dubious, though less obviously so in this case. The main problem with this claim is the fact that people who are involuntarily committed are going to be disproportionately inclined to overdose in the first place, so of course they're going to overdose more than the average junkie. The attached article lists a myriad of other correlations with overdose deaths, several of which co-correlate with being committed. This again means that, at best, the conclusions being drawn here are aggressively preemptive, and at worst, intentionally misleading. Very disappointed the Times let this through with this volume of misinformation.
21
One person I know who kicked the habit-- she gave up custody of her child to her parents (and never regained it-- story not over yet) -- was in rehab, released, forged checks, three years in jail, got out, got a job away from her former community-- and is fine-- living with a fellow and had a second baby. She needed the incarceration.. Cold turkey would not seem to be optimal... however, it seems to work for many smokers. How much do the private companies that run these places charge? What kinds of dividends do they pay their shareholders?? if any...etc.
Involuntary and committed by family members or police officers would seem to be a violation of basic civil rights. But sometimes people really have become nonfunctional (been there, done that).
10
Good God, this is some heartless stuff. I’ve never been more thankful to have already gotten over my own opioid addiction.
Locking people up against their will makes them resent you, not the drugs they turn to for self-medication.
6
@ubique Locking people up might make them resent you, but if you're a junkie stealing other people's stuff you'll find the rest of society resents you right back. Only one of those resentments is justified.
8
We as a nation believe and are in love with punishment, have a drug problem, lock you up and throw away the key.
Life is complex and at any moment we can fall between the cracks because there is no safety net. We are afraid of growing old because we know we wont get any treatment for dementia if our family members are dead we will roam the streets till we are dead.
Addiction needs special holistic approach with care. There are reasons why people turn to drugs to numerous to state here but just stopping doesnt cure the broken spirit. People dont destroy there own lives and the people who love them because they have nothing better to do.
Our prisons are an example of a complete failure by society. Rebranding them is just another society's lie to pretend we are doing something when we know we are doing nothing.
Remember the video of the mental ward at Kings County Hospital, in Brooklyn, the medical staff walked around a patient lying on the floor for hours till someone finally realized that the patient was dead, Epstein committed suicide in plain sight so why do we think that forcing a person to go cold turkey in going to help the drug scenario.
We are taking the lazy man's way out, talk that we are doing something and ensuring we dont do anything. We need all hands on deck to address these issues with a holistic approach that can be measure. What we are doing now, is disservice and we know it.
5
I worked at a meth clinic in a large city for almost three years; I got to know many of the patients, and I knew their histories (from typing up their intake and progress data).
Becoming and staying clean requires far more than just going cold turkey; most addicts need many types of support and instruction.
For example, most of the addicts in that clinic came from profoundly dysfunctional homes (violence, sexual abuse, emotional abuse, substance use) yet described their childhoods as normal or even happy -- many had no idea of what a healthy relationship was, and many had problems with authority figures, such as bosses, and therefore had periodic unemployment. Those serious problems can be addressed, however -- through therapy (to identify unhealthy patterns and learn new ones) and through role-playing exercises.
Virtually all belonged to social or familiar circles in which drug use was common; how were they supposed to find emotional support for staying clean? How were they supposed to deal with the trauma of limiting time with, or cutting off, relatives and longtime friends?
Many were undereducated because chaotic family lives, and an early turning to substances, made them poor students and sometimes dropouts.
All of the above can be addressed, but it requires time, effort, well-thought-out programs, dedicated counselors, and money. Simply forcing people to go cold turkey won't solve any of those problems, and the imprisoned will relapse.
19
@Doro Wynant I am a former drug addict/alcoholic. Everything you said was true. The other very true thing is that I was not able to maintain continuous sobriety until the trauma was addressed. I went to decades of AA/NA meetings, still could not maintain sobriety. AA/NA has a tendency to not address the trauma, and then make you do “steps” over it to see what your part was in causing your trauma. Sick. When someone introduced me to the work of Pete Walker, (Surviving and Thriving complex PTSD), and through a lot of work with a therapist specialized in trauma, I was finally able to make changes in my life. I refuse to ever go to another “meeting”. For me, they did a lot more harm than good.
10
Some people have mental conditions that prevent them from controlling their own behavior, to the point where they may pose a danger to others. Some people are so hopelessly addicted to drugs that they will rob and kill to finance their addictions. These people exist, and they must be isolated from the rest of society somehow if our civilization is to continue. Work on improving conditions and processes for sure, but do not pretend that there aren't people out there that need to be locked up, for everyone's good including their own.
50
@KM
Or... we could provide them with medical care that provides them either with their drugs or with an appropriate substitute such as methadone. If they don't have to steal to get the drugs, they won't.
Canada has such a program, where addicts can get their drugs and take them under medical supervision so that they do not overdose.
3
Is my "aunt" also sleeping on the sidewalk, defecating in public, shoplifting to buy the sugar treats that cause her diabetes, and shouting crazed epithets at random passers-by?
I certainly agree that involuntary addiction treatment should involve the best treatment methods like methadone rather than forced abstinence, but let's be real, drug addicts generally get busted not for using quietly in their own homes but for drug related crimes committed in public. As such, they lose the right voluntarily choose or reject treatment. We live in a cause and effect world.
57
@JP Why aren't rich addicts being treated the same way? Why aren't they manifesting these behaviors? Analyze this and the mistaken nature of the involuntary treatment movement becomes clear.
2
@JP: Interesting that you're completely unwilling to take responsibility for the world that creates addicts and for your part in sustaining that world.
But, hey, don't bother fighting for economic and social justice when you can just blame the people who are shafted by a rigged system.
Maybe read a bit -- or even just think a bit -- about the hardships that throw people into despair such that they start self-medicating and become addicts.
Nobody pops out of the womb thinking, "Hey, I want to grow up in a neighborhood with awful, underfunded schools; in a family riven by underemployment / unemployment and the accompanying constant stress and dysfunction; in an environment that will never enable me to blossom; in a cycle of despair that will lead me to life-killing addiction."
10
@sedanchair Do you know any "addicts" who are truly rich? There are plenty of heroin addicts that were once at least middle class, but the same drugs that chew through your brain and body tend to eat up your savings, career path, and social connections too, so by the time you're obviously an "addict" you're to appearances, "poor."
The difference here is craving vs compulsion. I know plenty of high functioning, 6-figure earners in NYC who use coke every single weekend and smoke weed more days than not. But it's not a compulsion. They can get through a workday or go to wedding without being high. This is partly due to the nature of the drugs used. Weed and "magic" mushrooms are not particularly addictive and coke and MDMA are much less addictive than drugs like meth or heroin.
In other words, the difference in treatment is not based on income but rather on behavior and similarly the typical behavior of the "addict" is not always a result of being poor but paradoxically tends to lead irrevocably to becoming poor as one loses a job, housing, social circle, etc.
Moralizing about the Wall Street banker doing coke lines in Up and Down, does little to improve the situation for anyone. Like it or not, drugs are de facto legal in the United States with one important caveat: don't use them in public and don't be a nuisance to the public. And yes, some of the "rich" people I know who do drugs are black.
13
When you have politicians make medical decisions via confinement laws-it is same as having them perform open heart surgery. These laws are normally knee jerk reactions with little support, as you have indicated, in actual fact finding.
I can see other legal issues. Now marjiuana is legal in many states and can be used for recreational use. So, if I am addicted to this legal drug can I be incarcerated? Even for Oxytocin- if I use it legally and am addicted to it can I be incarcerated? What about the right to be addicted to a drug if I want to be? What about people who are overweight and obese. Why not incarcerate them so that we can get their weight down. Trump is obese and if the law was changed maybe we could confine him. Not a bad idea.
1
You need not ask the permission of addicts any more that you ask the permission of children who are ill.
15
@David
Really these people have no rights? If that is the case why dont we tell fat people that they are only going to eat kale since they cant control themselves.
hopefully children have a loving parent who cares about them and will listen to sound medical advice. However that is not the case since some parent dont believe in vaccinations at all.
6
@David Should this policy apply to alcoholics?
1
In Communist China they’re rebranded as highly secured vocational training dormitories for Muslims, Buddhists and Christians. If you practice Falun Dafa and its tenets of truthfulness, tolerance and compassion, the prisons are spiritual intervention rehab prisons. That’s until an affluent organ transplant tourist or high-ranking Party member needs your corneas or liver.
3
Imagine your Aunt has a college degree, she's been a contributing member of society her entire adult life. Imagine, diabetes runs in your family. Imagen, your aunt works 10 hours days, she used to work 12 to 14, but that was when she just began her new business, now she's down to 10, she's been doing this 30 years. Her diet isn't bad, but she's overweight. She's married, and she's raised 2 very successful, happy children. She is also involved in her community and she' votes.
Now imagine your uncle. At some point he began taking drugs, illegal drugs, drugs that everyone knows are highly addictive. Imagine your uncle. He will do anything for his drugs, he steals and you even suspect that he's done worse. He lives on people couches, but often as not, he's living on the street. The few times you've seen him he's been incoherent and filthy. You know he's a thief because he's been in jail multiple times, but they never convict since the prisons are so full. Imagine, you're uncle has been in rehab before, but he often just walks away.
Imagine, your aunt and your uncle. One has a disease that has a lifestyle component to it, but science shows is also genetic, a disease which isn't developed through illegal activity and doesn't always strike people who have exactly the same lifestyle.
Now imagine, you're uncle, that man who made the decision to partake in an illegal activity that he should've gone to prison for in the first place.
Are they the same? Really?
19
@Pamela G. Imagine all drugs were legal, with dosage and quality regulated. Almost no one would steal to obtain their drugs (how many alcohol and tobacco addicts steal to get their drug of choice?). And overdose deaths would be far fewer. Most now occur from unregulated heroin/fentanyl.
Our current unfortunate circumstances are primarily a result of the war on (some) drugs and we can't solve this problem as long as we wage this war.
8
@Pamela G
Your apparent conclusion here (if I understand your point correctly), is exactly the opposite of what I believe to be descriptive of reality. In my opinion, the plight of your aunt, as well as your uncle, are identical. If you strip away the moral judgments, there is no difference between the two, especially if you are talking about a legal substance like alcohol (the most deadly substance there is, next to tobacco).
Voluntary treatment has been with recurrence rates of approximately 60%. The behavior of addicts often in fact is criminal ranging from theft to fraud and in many cases violence. The authors suggests that failing to label a person a criminal by choosing a non-criminal path now absolves them of their original criminal behavior. Perhaps they would prefer prosecuting them and therefore having the right to treat them as a criminal as more legitimate. To be clear, there are a minority of drug users who began their journey through no fault of their own (addicted post-operatatively). However, the vast majority of addicts made a choice and then victimized those around them in pursuit of their addiction.
21
@Chris
The authors are talking about people who have not committed a crime but are locked up solely for addiction.
6
We need to abolish prisons and jails as they currently exist. We don't need "corrections officers" as they don't correct anything nor do they do anything correctly.
Prisons are a nightmare of abuse and torture and sometimes even brutality and death. While they may protect us from some violent criminals who in fact do need to be separated from society too many, in fact millions are thrown into substandard, cold, flithy and left over remnants of 17th century prisons.
Prisons do no good. In fact they do more harm than good. Locking people away for non-violent crime for long prison terms is non-productive, inhuman treatment.
The prison system across the U.S. is corrupt and broken. We often see drunks, drug abusers, traffic offenders, petty thieves, and white collar criminals sentenced to prison while we know all too well that those persons are simply being expensively warehoused and forgotten. Then we strip of them of their rights, take them from their families and livelihood and expect them to reform themselves and change their lives....after we abuse them for 10-15 years.
What is the point of prison? Why do we cling to this archaic form or punishment or form or correction when we know all we do is harm the criminal and their families. Only violent criminals belong in prisons. No one else.
We desperately need to make dramatic changes. We also need to reform and change the judicial system and policing. We're doing more harm than good.
20
@Jay - apparently you or your loved ones have not been a victim of crime and therefore can so blithely throw around terms like "non-violent" offenders. If a drug dealer runs a criminal enterprise dealing addictive drugs to hundreds of people, participating through the supply chain in the criminal and violent activities associated with production and distribution of drugs, and funneling drugs to addicts who feed their habits through robbery, I would assume you consider them fine non-violent offenders. Spend some time with our prisoners and I will bet that you do not want them living next door, tending to your children, working at the desk next to you or being part of your community.
11
@Chris
And how much do you know about it? Being a crime victim is not a source of knowledge or wisdom; it is only a source of anger and resentment -- understandably, but that is not knowledge or wisdom.
5
How can they call it a treatment center with no medical treatment? Abstinence is not treatment. But I'd have no problem with locking up addicts to force them into actual treatment. I gotta figure someone in the grip of addiction isn't really making a free-will choice about staying addicted.
5
This column starts with a false premise. Eating poorly and not exercising is not illegal. Shooting heroin is.
Involuntary treatment is entirely reasonable for addicts who are committing crimes and unable (or unwilling) to seek private treatment. It is also a reasonable option for family members who have tried and failed to get help for the addict. The reality is that the alternative to involuntary treatment is prison (you know, because using heroin is illegal and stuff), so there is no ethical issue here. Safe injection sites just paper over the problem of addiction and are not direct paths to recovery.
All that said, I would agree that these should be real treatment centers, where clinical opinion is "the law" and the patients are treated as in-patient patients, not inmates. But I am also fine with requiring a judge (preferably in with counsel from an independent medical review board) to endorse a clinical recommendation for release.
5
@QED
The Massachusetts statute authorizing involuntary commitment to "treatment facilities" is not limited to persons who use illegal drugs. It also applies to persons with "alcohol use disorder."
5
@QED
Distributing and possessing heroin are illegal. Shooting heroin is not.
3
@QED I've actually visited a safe injection centre twice (overseas), bringing university students to find out about the harm reduction approach. The centre I have visited isn't just some room where people fix and then leave - there are medical personnel, social workers and drug counselors on site. They talk and get to know every user, and work hard to help them get ready to take their first, and subsequent, steps to recovery. They can refer them, and even walk them over to, services that can help to solve other problems, like mental health issues and homelessness. And they make sure they don't die.
The results? In a city that once had a rampant and very visible hard-drug problem, it's now pretty hard to find an obvious junkie roaming around. There are very few overdoses. Crime committed in order to buy drugs is way down. Have a look here, and follow the links for additional info: http://www.emcdda.europa.eu/country-data/harm-reduction/Netherlands
6
Drug use and abuse is a health issue, NOT a criminal issue. Portugal, in 2002 (!), decriminalized all drug use and abuse, and moved their resources from law enforcement, to health services. They have been successful (although the U.S. media would have you asking "Where's Portugal?"). We could too, if we'd wake up.
20
@Slann I'm willing to wager that very few people are arrested for quietly using drugs in their own homes. The police aren't kicking down doors to bust somebody smoking a J while watching Planet Earth or even the people doing a line on the coffee table while pregaming with friends before going out for the night.
People who get arrested do so for CRIMINAL issues that the commit on top of the drug use like using in public, public urination/defecation, assaults while high, stealing to support their habit, etc.
That crosses the line into being a criminal issue.
10
Two points that should be uncontroversial, yet continue to be denied by addict-apologists and bleeding hearts alike:
1) Addiction is not a disease. It is a failure of personal willpower.
2) If these addicts are addicted to controlled substances, then it's inaccurate to say "they've been involuntarily committed without committing a crime." Their substance abuse is illegal.
10
@asdfj You should expand your intellectual horizons and look beyond what you think you already know. For example, did you know that until recently the highest rates of opioid overdose occured because of prescription drugs? Many people became addicted because they had been prescribed opioids by physicians who were led to believe by pharmaceutical companies that treatment of chronic pain would not lead to addiction or dependency? This is the origin of a large part of the current opioid epidemic not personal weakness. It is a shocking story and if you base the solution on false premises, the epidemic will continue to worsen. Read what Portugal did 20 years ago when it faced a similar epidemic and where that country is today. In addition if you think this epidemic doesn't touch all of us, consider the costs of the response by police, fire dept, hospitals, doctors, nurses ER, insurers, Medicaid, Medicare, collateral damage to families who become impoverished, children who lose parents and are traumatized: all of this requires public services that are paid for by taxes.
11
@asdfj , no, addiction is not a matter of willpower. Read the science. Heres an intro: https://www.health.harvard.edu/blog/is-addiction-a-brain-disease-201603119260
8
@Kilroy71 not true. Science is not settled and won’t be settled by a blog post. Plenty of researchers present opposing arguments: consider the book “Addiction and Choice” by Heather and Segal (Oxford UP). Moreover, simple common sense shows this notion of addiction as an involuntary brain disease to be untrue. Opioids, alcohol and other drugs are available in every country in the world yet levels of addiction vary widely. What, Americans are especially prone to brain disease? Why?
4
Stop asking the criminal justice system to do things it was never designed to do. Treating mental illness, treating drug addiction, providing restorative justice, "rehabilitation" of oftentimes lifelong criminals --- these are things the criminal justice is ill-equipped to do.
6
The clear first step is to make treatment readily available to anyone who wants to start treatment. It's crazy to lock people up in involuntary treatment when they can't get treatment when they want it.
That said, there may still be a role for involuntary treatment, at least for a few days. When someone is revived from overdose using naloxone, they should be held for at least a few days for medical monitoring. And during those few days, conversations with a recovery coach might induce the person to start voluntary treatment, or take some harm reduction steps.
12
This article rests on the unproven assumption that addiction is an involuntary disease and that addicts are like cancer patients: helpless victims of an external affliction. This is not true. Studies show that while there may be a genetic predisposition to addiction, addicts have control over their behavior. Criminalization of addiction is counter-productive but so is its medicalization. If adults want to waste their lives, why should society intervene? Billions of dollars are wasted on fighting the opioid “epidemic”, as if it were smallpox or the plague, instead of trying to understand the social and cultural factors that push people to seek oblivion. And ultimately, even understanding of these factors may not change people’s behavior. Smoking kills and everybody knows it, yet some percentage of the population still smoke - and ethically speaking, it is their right. Instead of locking people up, whether in jails or in “rehabs” that don’t work, just legalize most drugs and let people die any way they choose.
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@Mor
The difference is smokers do not in general become homeless, defecate on the streets and commit crime to pay for their cigarettes.
In order for legalization to work you have to be willing to let addicts overdose without intervention from services paid by taxes, and die on the streets in public places etc, so that the addicts who refuse to change die out.
8
While I agree that jailing anyone to treat them for addiction involuntarily is ethically wrong, I think it is also worth mentioning that this system is both classist and racist. The rich, white people who have these addictions are more likely to be placed in a private treatment facility, while poor people of color are disproportionately placed in these for-profit prisons. Also, people who live in poverty are more likely to get an addiction to a lethal drug, and subsequently end up in one of these prisons as opposed to a private practice that their richer counterparts can afford. Addiction is a disease that affects people from all walks of life, and yet most of the people in prisons (and these facilities) are nonwhite. This system harms all people, but it harms people of color much more frequently than it does white people. Even though these jails are rebranded as something positive, they are still prisons, and almost all, if not all, prisons disproportinately harm people of color. Although they only make up 12.6% of the population, black people make up 37% of prison populations. This is an issue that affects these treatment facilities as well, because at their hearts they are still prisons. This article did a great job exposing the ethics and morals (or lack thereof) of the treatment facilities, and showcased that this system harms everyone involved, but we cannot overlook the overwhelming effect they, and all prisons, have on people of color and people living in poverty.
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@Riley Morris
I wonder how many of the people rejoicing here that addicts are punished and deprived of civil rights would be surprised to learn the number of judges, physicians, oil workers, professors, and other people of means are addicted to opiates, and are treated intelligently by pain specialists who help them score via legal prescriptions, and prevent ODs.
The real crime is and always has been being poor.
2
This policy is a sign that for many people, addiction is something that makes them angry at the addicts for being "nuisances". "I" am allowed to have my crisis of "dealing with" addicts (by any means necessary), but other people aren't allowed to have their crises, because it's inconvenient for "me".
4
What I am not seeing here is any distinction made between jailing people who need treatment but have not committed any criminal offense and designating certain prisons/jails as "treatment facilities" for those who have been convicted and are serving a sentence. The latter exist and some of them even provide medication assisted treatment.
3
There are so many of these civil rights violations, like involuntary commitment and civil forfeiture. It makes me wonder if the violation, not the issue at hand, is the real point. Is the purpose just to get us used to ignoring civil rights, at first in relatively harmless doses like this? Are we being taught that the leash is no harm...until it is drawn tight?
3
This is the exact thinking that has created the current homeless crises across the US. It is not the high cost of rent, as proof we can look at the population of recently arrived undocumented immigrants. Several million people have entered the US with very little money, limited English, and only the ability to work under the table as a means to support them. Many of these people moved to the LA or NY areas, yet the homeless populations in those towns lack a large hispanic proportion.
Addiction can stem from untreated mental health issues (self medication). Allowing someone who is either mentally ill or addicted to languish on the street is cruel. Many of the patients are incapable of making the decisions necessary for their daily needs.
So, yes, a judge should be able to remand someone to treatment against their will, since they are legally incapacitated and cannot make decisions on their own. A family member should have the powers of the state available to help someone who cannot help themselves.
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@James These programs do nothing to ameliorate homelessness, and in many ways make it worse by perpetuating the same cycle of incarceration. Only housing solves homelessness--give people housing (even if they are addicted to drugs, even if they suffer from severe mental illness) then worry about everything else.
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