People proclaim that drug addicts should be put into treatment for a disease rather than into prison. The disease model of addiction is considered an enlightened alternative to the moralistic view that addicts are bad people. However, addictions treatment has been co-opted into the war on drugs. It is largely ineffective in disentangling drug users from the criminal justice system.
Mainstream addictions treatment is based on the belief that addiction is a disease that dooms its victims to insanity, institutionalization and death. Treatment is impossible if the patient is unwilling to abstain. There is no cure. Everyone who adheres to the rules of treatment will live a better life in remission. Anyone who persists in using drugs has not hit bottom, and must therefore suffer more.
With its emphasis on abstinence and personal reform, addictions counseling became a government-sanctioned profession during the war on drugs. A natural fit. Criminal justice officials coerce people into treatment. Addictions counselors enforce abstinence by making it a condition of treatment.
Mainstream addictions treatment helps people who have the stability, support and will to redefine their lives in the mold of the 12-Step recovering community, but it is largely irrelevant in the day-to-day survival of the young people who fill our jail. If we want to disentangle drug-related offenders from the criminal justice system, public policy cannot be driven by ideological commitment to criminalizing them for using drugs. They use drugs regardless of treatment and prison.
Fresh research shows that supervised drug-maintenance and weaning is more effective than enforced abstinence. But the shortsighted laws that govern medication-assisted treatment give the pharmaceutical and medical industries financial incentive to perpetuate chaos. Moralistic commitment to abstinence has enabled pharmacists and doctors to profit by selling opium to treat alcoholism, heroine to treat morphine addiction, and methadone to treat heroine addition. Suboxone is the newest opiate being peddled as a treatment for drug dependence. It helps some people stay out of trouble for relatively protracted periods of time. But the drug users who are entangled in the criminal justice system know how to mix suboxone into their cocktails, along with street drugs, and other drugs doctors distribute.
It doesn’t matter whether addiction is or is not a disease. The treatments for the disease do not disentangle prisoners of the drug war from the criminal justice system.
If we want to reintegrate the people who live on the battlefields of the drug-war into our larger community, we have to provide them with opportunity to meet three needs. They need opportunity for stable housing and employment. They need personalized medical treatment from knowledgeable doctors who understand the conflicting interests inherent in providing medication-assisted treatment to drug addicts. They need trustworthy empathetic counselors and mentors who are not beholden to the courts; who can respectfully guide them in reducing the harm caused by their drug use.
Many County Courts are partnering with “nonprofit organizations” to provide “addictions treatment” to felons who would otherwise be sent to prison. The felons receive “evidence based” treatment that was conceived in the ideological belief that addiction is an incurable disease, and abstinence is the only conceivable treatment.
Most drug-related offenders grow up learning life’s lessons in a world of drugs. They use drugs in a desperate but doomed effort to achieve and maintain an inherently transient state of perceived wellbeing. They excel in rationalizing regrettable behavior that satisfies pressing desires.
Addictions treatment helps some felons reform. But recidivists who have not been sufficiently beaten by the stick of prison will not swallow the carrot of treatment. They see addictions counselors as agents of the court who do not provide the wisdom, safety and support necessary to face the hidden fears that drive their uncontrolled drug usage.
We can reduce the harm caused by persistent problematic drug use by supplementing “evidence- based” treatment with nonjudgmental guidance that is not tied to the moralistic ideology that constrains addictions treatment protocols. Loving understanding and respectful guidance help people face scary truths and change their behavior. That is evidence based.
The disease model of addiction emerged more than half a century ago as an enlightened and compassionate alternative to the judgmental view that addicts are morally deficient. The Hazelden–Betty Ford foundation described the plight of addicts in the bad old days before Hazelden’s founders “invented modern addictions treatment.”
Imagine for a moment that it is 1949, and that someone you love is alcoholic. As you struggle with this fact, you quickly learn about three prospects for this person’s future: One is commitment to a locked ward in a mental hospital, sharing facilities with people diagnosed as schizophrenic. Another is that alcoholism will lead to crime, which could mean years in prison. And third is a slow sinking into poverty and helplessness — perhaps life on “skid row.” In all three cases, your loved one’s condition will be denied, ignored, or denounced as evidence of moral weakness.
Sadly, in the 65 years since the “invention” of “modern addictions treatment,” the bad old days have gotten worse. Many more people are in prison for drug-related offenses, and the schizophrenics have to share facilities with them. Also, an increasing number of people who suffer from problematic drug use are homeless.
If “modern addictions treatment” is supposed to be nonjudgmental, how did it come to pass that so many certified addictions counselors (CACs) colluded with the criminal justice system in the war against people who use drugs? I witnessed pioneering CACs pitch their treatment programs to criminal justice officials in the 1980s and 90s. They sincerely believed they were saving lives, doing the right thing.
Most addictions counselors believe that addiction is a progressive disease, with dire consequences unless it is treated. Denial is a symptom of the disease. Abstinence is essential for treatment, which is based on the 12-steps. Every patient who participates in treatment, works the 12-steps, and attends meetings will experience recovery. Failure to recover is indicative of the patient’s denial, and/or failure to adequately follow the treatment regimen. Those beliefs blind addictions counselors to the ways in which they disregard and deny the reality of other people’s lives. Addictions counselors are largely unaware of the conflicting interests and ideologies that shape the service they provide to people who are forced into treatment by the criminal justice system.
Denial is a useful concept. We humans rationalize and justify behavior that satisfies our pressing, immediate wants, even though our choices may hurt others, and ultimately hurt ourselves. That’s the way we are. We blind ourselves to inconvenient truths, and deny them.
By proclaiming denial to be a symptom a disease, addictions counselors were able to justify forcing vulnerable people into treatment, even when the “patients” claimed that they did not have the disease. Some of the pioneering CACs actually asked researchers to develop diagnostic procedures that would not miss a single dependent person, no matter how many nondependent people were erroneously put into treatment.
By proclaiming denial to be a symptom of their disease, addictions counselors twisted a useful concept into ammunition for the war against people who use drugs. Maybe the counselors’ denial of their personal interests enabled them to collude with the criminal justice system, and thereby disregard the reality of vulnerable people’s lives.
Addictions counselors gained turf in the mental health field in the late 1970s through the 80s. They identified themselves as recovering addicts who had been saved by twelve step programs. They fought for professional status and third party payment, claiming they were the only practitioners who could save the lives of people who were suffering from the progressive disease of addiction. Untreated addicts were doomed to insanity, incarceration, and/or premature death.
The original certified addictions counselors (CACs) were true believers. Anyone who did not embrace their view of addiction was in denial, uneducated or evil. They took it upon themselves to educate judges, probation officers and prison officials about the disease of addiction, and about the vital need for the criminal justice system to mandate drug-related offenders to their programs. I actually heard an eager CAC refer to a judge as “educable”. Her sense of mission obscured all awareness of presumption.
The early CACs loved to talk about denial and enabling. They were the veterans who knew all the tricks of the insidious disease. They told stories of how they were able to detect denial in people who fooled themselves into thinking they were not addicts. And they told the same joke over and over — Question: How can you tell if an addict is lying? Answer: His lips are moving. Their chuckle carried love as well as superiority. Most of them were good people who meant well. But their sense of mission prevented them from recognizing that they were operating a professional treatment service under the influence of conflicting influences.
The early CACs were perfectly positioned to blossom as an arm of the war against drugs. They had pee cups, and they helped the courts enforce abstinence. They believed that anything other than enforced abstinence as a condition of treatment was close to criminal.
A lot should be said about the consequences of addictions treatment becoming an arm of the war against drugs. Right now, one of the most glaring dangers is the unquestioned assumption that we need to transfer funds from prisons to treatment programs. Most of the young adults caught in our criminal justice system grew up on the battlefields of our war against drugs. They began using young, and they live in a world of drugs, both in and out of prison. They do not need treatment for a disease. They need stable environments, jobs, respectful understanding and loving guidance.
We have wasted a lot of money conducting science-based research to see if it’s a good idea for health-care workers to be able to give clean needles to people who inject drugs. The US Department of Health and Human Services opened the money spigot to the research industrial complex by prohibiting the use of federal funds for syringe exchange programs until there was sufficient research to determine if such programs were effective and safe.
Did we really need a lot of expensive research to see if intravenous drug users use clean needles when they are available? Intravenous drug users are a lot like us. They want to protect themselves from harm. They use clean needles whenever possible. Clean needles don’t carry infection.
And we really didn’t need a lot of expensive research to see if clean needles recruit drug addicts? Of course some druggies may choose to snort or smoke rather than use a dirty needle. But, in the context of all the societal problems driving our children to drugs, its just plain ridiculous to think that the presence of a clean needle is a major factor leading to the unnecessary pain of drug addiction.
Someone said crack is better than coke because with coke you had to keep hitting it, and with crack you take a hit and you’re good.
So what does good mean?
I’m a total lightweight. To me good is — yeah good, I do a drug, slide a while, and settle down for bed.
But that is not the way the guys see it. They see it — shit yeah, its easier to stay high longer – long as you can.