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.