If Addiction Is a Disease, Why Is Relapsing a Crime?

When Julie Eldred tested positive for fentanyl in 2016, 11 days into her probation for a larceny charge, she was sent to jail.

Such outcomes are typical in the American criminal justice system, even though, as Ms. Eldred’s lawyer has argued, ordering a drug addict to abstain from drug use is tantamount to mandating a medical outcome — because addiction is a brain disease, and relapsing is a symptom of it.

Monica Ramos

Monica Ramos

Ms. Eldred’s case, now before the Massachusetts Supreme Judicial Court, has the potential to usher in a welcome change to drug control policies across the country. The case challenges the practice of requiring people with substance use disorders to remain drug-free as a condition of probation for drug-related offenses, and of sending offenders to jail when they relapse.

The prosecution’s counterargument — that the disease model of addiction is far from settled science — is weak. The National Institute on Drug Abuse, the American Medical Association and the Diagnostic and Statistical Manual of Mental Disorders, which is the final authority on psychiatric conditions that qualify for insurance reimbursement, all define addiction as a chronic, relapsing brain disorder that, like diabetes and heart disease, is caused by a combination of behavioral, environmental and biological forces.

The prosecution’s argument is also somewhat beside the point, because it is clear that relapses are common in people struggling to overcome addiction, whether one considers it a disease or not; specialists say that most opioid addicts relapse an average of five to six times before achieving full sobriety.

It is fair to say, as prosecutors and several briefs filed in the case do, that people who suffer from substance use disorders are not wholly unable to choose to abstain from drug use. Most addicts do, after all, manage to refrain from using in any number of public places, in the course of any given day. But their ability to choose rationally and consistently is still impaired, by both brain changes caused by chronic substance use and the sheer force of addiction itself. “It’s not that they don’t have free will,” says Mark Kleiman, a professor of public policy at New York University. “It’s that they are exerting that will against such a colossal force.”

It’s also true that addicts can and do respond to incentives. But the balance of evidence suggests that carrots work far better than sticks, and that in any case, the particular stick of jail time thwarts the treatment process.

“Our patients are far less likely to talk honestly about their relapses and their struggles with recovery if they think it’s going to land them in jail,” says Sarah Coughlin, a social worker and addiction specialist in Charlestown, Mass. “It puts us in a tough spot, because it breeds mistrust.” It also breeds fear: As The Boston Globe reported, one woman committed suicide in the bathroom of a Lowell, Mass., drug court after she watched at least 23 of her 41 fellow probationers get sentenced to jail for relapses and other violations, and after she became convinced that she would soon be sentenced as well.

Of course, criminalizing relapse isn’t the only absurdity that exists at the intersection of drug addiction, criminal justice and public health. As a recent Times article explained, states across the country are enacting laws that allow for homicide charges against just about anyone connected to an overdose death, even if that person is also suffering from addiction.

The irony is both dark and profound: Only in death do drug users become victims. Until then, they are criminals.

In addition, a vast majority of American prisons deny opioid addicts access to medication-assisted therapy, or MAT, which uses Food and Drug Administration-approved medications that can relieve opioid cravings and withdrawal symptoms. Most addiction specialists say MAT is far and away the most effective treatment for opioid use disorder.

Anti-MAT policies have a number of unconscionable effects. They mean that incarceration necessarily disrupts a promising treatment before it has time to work. They also force addicts who are in treatment but faced with incarceration to rapidly and dangerously taper off serious medications. And they increase the risk of post-incarceration overdose deaths. “A lot of the overdoses that lead to homicide charges occur upon release from jail,” says Josiah Rich, a Rhode Island doctor who treats addiction in the prison system. A study by Dr. Rich and his colleagues found that providing MAT to inmates suffering from addiction could reduce such deaths by more than 60 percent.

Policies that punish relapse with jail time and keep sufferers from proven treatments are part and parcel of a nearly 50-year war on drugs, predicated almost entirely on criminalization, that no reasonable person would say is working. It costs about $33,000 a year to imprison someone for a nonviolent drug offense and $6,000 to treat someone with MAT.

A ruling in Ms. Eldred’s favor would mark a positive step toward rethinking this strategy.

It would not, as some critics contend, necessitate freeing everyone with a diagnosis of a substance use disorder from facing any consequences for drug use. “It doesn’t have to be, and it shouldn’t be, an all-or-nothing proposition,” Mr. Kleiman says. “You still want to have consequences, but they should be fair.”

The outcome of the Eldred case won’t have much effect on Ms. Eldred herself. With the help of her lawyer, she was diverted into a treatment program, and is now in remission and rebuilding her life. But a decision for Ms. Eldred could help ensure that other people suffering from addiction get the chance she did.

Original Article


Posted in the New York Times on May 29, 2018, the question is asked, If Addiction Is a Disease, Why Is Relapsing a Crime?

At the start of this article, a personal experience of Julie Eldred is shared, focusing how ways in which attorneys argue that “ordering a drug addict to abstain from drug use is tantamount to mandating a medical outcome.” As many people may consider this point to be only of the benefit for a convicted felon in possession of an illicit drug, we must consider just how many people are affected or influenced by addiction. Addiction Specialists from The Kraft Group Inc. explore the meaning of the disease concept of addiction. As described by the American Medical Association and the Diagnostic and Statistical Manual of Mental Disorders Edition Five, addiction is a chronic and relapsing brain disorder.

The Disease Concept of Addiction identifies three major attributes defining substance abuse as a medical and biological disorder. First is the Genetic Predisposition: a person may adopt the gene of addiction from family members, which may remain dormant or dominant in their biological parent. This is also significant, as the gene of substance addiction can be passed down to offspring. A study reported on May 15, 2018 by Enoch and Goldman explored that when a parent has a drug or alcohol addiction, the child had an 8 times greater chance of developing an addiction. Second is Impulsivity: persons who identify with addiction oftentimes are co-occurring or have a duel-diagnosis of mental health impairment such as ADHD or OCD in addition to substance use. Put simply, addiction is an impulse control disorder, where the addict experiences obsessive thoughts and compulsive behaviors, to which they struggle with interventions to alleviate the intensity of a desire to use. Third and last is Trauma: a person struggling with addiction is typically attempting to avoid processing any type of traumatic event, which The Kraft Group Inc., believes to be an alteration in one’s life that was unplanned. This can be determined as a major life event, or a smaller interruption in a desired life path.

Reflecting on the New York Times question, a point was made exploring that “policies that punish relapse with jail time and keep sufferers from proven treatments.” Understandably, society is attempting to regulate substance abusers and avoid collateral damaging effects of the drug epidemic. However, incarceration is not always the necessary outcome for individuals who suffer from the disease of addiction. Instead, intensive, collaborative, effective treatment is the antidote. This was the case for Julie Eldred, who was sentenced to treatment instead of incarceration and is now in remission. The Kraft Group Inc. works in collaborated with Probation Officers to ensure a more helpful approach to the community and our individuals struggling with addiction, instead of putting them further in harms way.


Stephanie Zeman, M.Ed., MSW, LSW, LCADC, PhD. Cand.
Clinical Director
Individual and Couples Therapist

 

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