William R. Kelly Ph.D.

Crime and Punishment

Addiction

Substance Abuse, Neuroscience, and Crime

What is the relationship between substance abuse and crime?

Posted Apr 26, 2018

There is an undeniable link between drug and alcohol abuse and criminal justice involvement.  The prevalence of substance abuse among those in the American criminal justice system is six to eight times its prevalence in the general population.  The vast majority – upwards of 80% -- of individuals in the justice system have a substance use disorder including addiction, dependence or abuse.

There are several ways that illegal drugs can lead to criminal justice involvement.  Possession of drugs and/or drug paraphernalia, being under the influence, drug dealing and drug trafficking, and manufacture of drugs are common pathways into the justice system.  So is committing crime to support a drug habit.

The war on drugs, our fifty year, $1 trillion attempt to control the supply of illegal drugs has relied mainly on the criminal justice system and punishment to solve the nation’s substance abuse problem.  One would be hard pressed to find a judge or prosecutor who in a moment of candor would admit with a straight face that this war has been successful.  Take a measure as simple as the street price of drugs.  All else equal, we would expect street prices to increase if supply was significantly reduced.  We have essentially seen the opposite.  Then there is the recidivism rate of drug offenders, which is north of 70%.

The primary reason supply control efforts have failed to keep drugs from entering the U.S., from being distributed once in, and from being sold on street corners is because there is so much money to be made due to incredibly high demand and an extraordinarily large market.  Drug manufacture, distribution and sale are big business, involving phenomenally well-organized and resourced cartels, especially those in Mexico.  Because the cartels are so effective and strategic, and because demand is so strong and there is so much money to be made, supply control is destined to fail.

One of the major fallacies of U.S. drug policy is that it is largely based on the assumption that drug use is a choice.  The logic seems to be that we can compel drug users to make better decisions by threatening them or punishing them.  Neuroscience goes a long way in helping us understand why this approach is fundamentally flawed and why we cannot punish our way out of a drug problem.

Addictive drugs work through the reward regions of the brain by releasing dopamine, the neurotransmitter associated with pleasure and reward.  Those areas of the brain impacted by the release of dopamine regulate reinforcement learning, among others.  Because of the way addictive drugs cause the release of dopamine – by bypassing the normal controls that govern its release, addictive substances cause an exaggerated release of dopamine, signaling to the brain that this is much better than expected, causing ingestion of drugs to be considered much more valuable than other activities or goals.

The brain chemistry of addiction clearly shows us that substance abuse is not simply a matter or choice, or lack of moral strength or willpower.  It also helps us understand why the threat of punishment or actually experiencing punishment often takes a back seat compared to the positive response in the brain to using drugs.

The picture becomes more complex (and more compelling for the “punishment doesn’t work” perspective) when we understand that substance abuse can result in significant impairment to a variety of cognitive activities.  Sustained drug use can cause impairments or deficits to sustained attention, behavior inhibition controls, being future oriented, planning, cognitive flexibility, working memory, arousal and emotional regulation, and higher order cognitive skills, among others.

Overall, drug abuse has adverse consequences for brain structure and function.  These effects are on various aspects of cognition, in turn impacting behavior in a variety of negative ways.

Perhaps we can forgive Nancy Reagan’s 1980s solution of “Just say no.”  Today, we understand much more about the neurobiological and behavioral consequences of substance abuse.  What the evidence clearly indicates is that demand reduction through effective, evidence-based treatment is the only viable path forward.

Unfortunately, we have very little evidence-based treatment capacity in either the private-pay or public health arenas.  Alcoholics Anonymous and Narcotics Anonymous are not evidence-based treatment, although they constitute the exclusive or primary model used in many treatment facilities in the U.S. today.  It is time for substance abuse treatment to catch up with the science and become more broadly incorporated into psychological, psychiatric and addiction medicine practice, especially in the public health arena.