5 Ways We Punish Addicts - And Why We Should Stop

A compassionate approach toward addiction is more effective

Posted Oct 13, 2014

shaking finger to shame person
The way Americans look at addiction is starting to change, according to recent Pew Research Center statistics. Among 1,821 adults polled, two-thirds now say drug abusers need access to treatment rather than jail time. 

It’s a mindset also endorsed by the White House, whose proposed 2015 drug strategy includes additional funds for and greater emphasis on treatment and prevention and which notes, “Substance use disorders are not just a criminal justice issue, but also a major public health concern. Decades of research demonstrate that addiction is a disease of the brain — one that can be prevented, treated, and from which people can recover.”

Yet despite growing acceptance for a more compassionate approach, we still have a long way to go in terms of how we treat the actual person in the grip of an addiction. Too often, we dismiss them as weak-willed, immoral pleasure seekers rather than recognizing the illness behind the actions.

Here are five ways we continue to punish addicts, along with a few reasons we should stop:

1. Breaking addicts in order to fix them
Far too many treatment programs still utilize harsh confrontation and shame-based approaches in the name of breaking addicts down in order to build them up again. It’s sometimes labeled “tough love,” but often comes without the love.

Why it’s a bad idea: Treatment is more effective when it helps the addict understand what is behind their substance abuse and shows them strategies for dealing with it. Studies confirm that those battling an addiction are likely to have plenty of shame already. Adding to the guilt and blame is a way down, not up.

2. Imposing harsh sentencing that sidesteps the real problem
Stories abound of three-strikes and other mandatory sentencing provisions that lock up non-violent drug users. Of those incarcerated, only about 10 percent will receive treatment for their addiction.

Why it’s a bad idea: Jail time doesn’t help drug users overcome their problem. Instead, it means taxpayers pay the price for the incarceration and the health costs related to the addiction as well as for the criminal activity they are likely to return to after release. A 2012 study noted that sending drug abusers to treatment in lieu of prison could cut crime and save the criminal justice system (and taxpayers) billions. It can also hold the addict accountable for completing treatment and help spur recovery.

Drug court, put into effect more than 20 years ago as a way of diverting non-violent offenders into treatment programs, is one model that is a documented success. The National Association of Drug Court Professionals notes that “drug courts are six times more likely to keep offenders in treatment long enough for them to get better”, and “75 percent of drug court graduates remain arrest-free at least two years after leaving the program.”

3. Banning welfare benefits – for life
In several states, anyone convicted of a drug-related felony is forever prohibited from receiving Supplemental Nutrition Assistance Program (SNAP) benefits. It’s a holdover from welfare reform implemented during the Clinton era.

Why it’s a bad idea: If your first reaction was “Sounds smart,” consider the story of Christine McDonald. She’s a single mom who lost her eyesight after deciding not to take a medication that could’ve hurt her unborn child. She was also convicted of a drug-related felony a decade ago. Because of that, she is ineligible for food stamps.

“You couple finding a job with a criminal record, with having no eyeballs, you’re going to face some societal barriers,” McDonald told the St. Louis Post-Dispatch. Most frustrating to McDonald is that the law applies only to those convicted of drug offenses. “If I would’ve killed someone I could’ve gotten food stamps.” She now lobbies to encourage the last few holdout states to strike down the provision.

Besides the obvious unfairness of singling out drug users, denying a helping hand to those who are struggling to rebuild their lives only makes it more likely their problems will resurface, the cycle will continue and we’ll all suffer.

4. Criminalizing prenatal drug abuse

Tennessee’s legislature recently passed a bill allowing law enforcement to bring criminal charges against pregnant women if their dependence on drugs causes their child to be born addicted, or is harmed or dies because of the drug. A few states, Tennessee included, already have the power to force a woman to enter a drug treatment program, but Tennessee’s new ruling makes it the first state in the nation to call for jail time. The idea, supporters say, is that mothers will seek addiction treatment rather than risk harm to their child and possible criminal charges for themselves.

Why it’s a bad idea: Groups that are close to the issue – the American Medical Association and the American Academy of Pediatrics, among them – believe that just the opposite will happen. Instead of seeking help, women struggling with addiction are more likely to avoid getting prenatal care or help for their substance abuse because of the fear it might lead to criminal penalties.

The bill received a last-minute amendment that allows charges to be dropped if the woman enters an approved treatment program, but even with that softening, a chilling effect is expected. A better plan is to go back to a more humane “Safe Harbor” approach that helps pregnant women go to the front of the line for addiction treatment. Ironically, Tennessee had just such a plan in place but gave up on it after only a year.

The Tennessee governor signed the legislation into law over the objections of several medical and women’s rights groups, but he did include an unusual sunset provision that requires it to be revisited in 2016.

5. “One Strike and You’re Out” and “No Fault” Evictions
In the 1980s and 1990s, drug-related violent crime skyrocketed. Several regulations were enacted in response, including eviction rules that allowed landlords to boot out public housing and public assistance tenants if they or anyone seen as under their control engaged in criminal activity, including first-time drug use. Despite challenges, the provision was upheld by the Supreme Court in 2002. Among the evictions: tenants whose resident grandchildren smoked marijuana in the housing project parking lot, a tenant whose daughter was caught with cocaine three blocks from the apartment, and an elderly, disabled man whose caretaker was found in the apartment with cocaine.

Why it’s a bad idea: The idea of creating a safe environment for public housing tenants is a laudable one, but suddenly making a person or an entire family homeless, including those who may know nothing of the drug use, can do much more harm than good. A 2013 report prepared for Congress noted that the “one strike” and “no fault” ruling was created in an era with much higher drug-related violent crime than today and may actually work against the goal of mending families. Intervening through a drug court rather than an eviction promises a much better outcome.

Calling on Compassion

Addiction is frustrating, so it’s understandable that we might turn to punitive measures in the hopes of waking addicts up to the damage they cause themselves and others. But this approach ignores the fact that addiction is far from a choice; it’s a disease that hijacks the brain. In addition, it often goes hand in hand with issues such as depression, anxiety and early trauma.

Dealing with this complexity, and helping the addict deal with it, can be overlooked when the goal is simply punishing “misbehavior.” If our hope is really lasting change, we’ll have greater success if we put our energy into giving addicts a vision of the person they can be rather than punishing the person they’ve become. 

David Sack, M.D., is board certified in psychiatry, addiction psychiatry, and addiction medicine. As CEO of Elements Behavioral Health he oversees addiction treatment programs at Promises Treatment Centers in California and Texas, The Ranch outside Nashville, Lucida Treatment Center and The Recovery Place in Florida, The Right Step in Texas, Journey Healing Centers in Utah, Clarity Way in Pennsylvania, and Sundance Center in Arizona.  You can follow Dr. Sack on Twitter @drdavidsack.

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